'/:■ 


f  coc*«^^; 


;F^(-E-:NfGHTINftI 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 

GIFT  OF 
DR.  AND  MRS.  ELMER  BELT 


DONATION    BY 


DR.  AND  MRS.  ELMER    BELT 


y/^r-i 


r<yviXXy 


O 


NOTES  ON  NURSING: 


vVHAT  IT  IS,  AND  WHAT  IT  IS  NOT. 


BY 


FLORENCE  NIGHTINGALE, 


WITH    SOME    ACCOUNT    OF    HER    LIFE, 


BOSTON: 
WILLIAM    CAllTEIl,    5    WATER    STREET 

1860. 


AC 
B 


PREFACE. 


The  following  notes  are  by  no  means  intended  as  a  rule 
of  thought  by  which  nurses  can  teach  themselves  to  nurse, 
still  less  as  a  manual  to  teach  nurses  to  nurse.  They  are 
meant  simply  to  give  hints  for  thought  to  women  who 
have  personal  charge  of  the  health  of  others.  Every  wo- 
man, or  at  least  almost  every  woman,  in  England  has,  at 
one  time  or  another  of  her  life,  charge  of  the  personal 
health  of  somebody,  whether  child,  or  invalid,  —  in  other 
words,  every  woman  is  a  nurse.  Ea- ery  day  sanitary  knowl- 
edge, or  the  knowledge  of  nursing,  or  in  other  words,  of 
how  to  put  the  constitution  in  such  a  state  as  that  it  will 
have  no  disease,  or  that  it  can  recover  from  disease,  takes 
a  higher  place.  It  is  recognized  as  the  knowledge  wliich 
every  one  ought  to  have  —  distinct  from  medical  knowl- 
edge, which  only  a  profession  can  have. 

If,  then,  every  woman  must  at  some  time  or  other  of  her 
life,  become  a  nurse,  i.  e.,  have  charge  of  somebody's  health, 
how  immense  and  how  valuable  would  be  the  produce  of 
her  united  experience  if  every  woman  would  think  how  to 
nurse ! 

I  do  not  pretend  to  teach  her  how,  I  ask  her  to  teach 

herself,  and  for  this  purpose  I  venture  to  give  her  some 

hints. 

(ui) 


TABLE    OF    CONTENTS. 


Florence  Nightingale 1 

Index ...  6 

Ventilation  and  WARinNG 11 

Health  of  Houses 19 

Petty  Management 27 

Noise 34 

Variety 44 

Taking  Food 48 

What  Food  ? 53 

Bed  and  Bedding 60 

Light 64 

Cleanliness  of  Rooms  and  Walls    ...  66 

Personal  Cleanliness 70 

Chattering  Hopes  and  Advices         ...  72 

Observation  op  the  Sick 79 

Conclusion 95 

Appendix .        .  103 

(iv) 


FLORENCE  NIGHTINGALE. 


In  the  year  1820,  in  Florence,  that  lovely  city, 
"  where  earth  and  sky 
Are  picture  both  and  poetry," 
was  bom  the  younger  of  the  two  daughters  of  William  Shore  Night- 
ingale, Esq. ;  and,  in  memory  of  her  birthplace,  its  beautiful  name  was 
given  to  her  who  will  be  known  to  all  time  as  Florence  Nightingale. 

Her  father,  William  Shore  Nightingale,  son  of  William  Shore,  Esq., 
of  Tapton,  is  a  descendant  of  the  ancient  Derbyshire  family  of  Shore 
—  of  which  Lord  Teignmouth  is  the  representative  of  another  branch. 
He  assumed  the  name  of  Nightingale  by  the  Prince  Regent's  sign  man- 
ual in  1815,  in  accordance  with  the  will  of  his  maternal  uncle,  Peter 
Nightingale,  whose  niece  and  sole  heiress  his  father  had  married.  In 
early  life,  in  1818,  he  married  Frances,  daughter  of  William  Smith, 
Esq.,  formerly  M.  P.  for  Norwich,  a  zealous  laborer  in  the  cause  of 
slave  emancipation,  and  a  benevolent,  eaimest  man.  By  inheritance, 
Mr.  Nightingale  possessed  large  wealth,  and  the  ample  estates  of  Em- 
bley  Park,  Hampshire,  and  the  Lea  Hurst,  Derbyshire. 

The  e;  rly  youth  of  Florence  Nightingale  was  passed  under  circum- 
stances well  calculated  to  foster  an  elegant  mind  and  a  tender  heart. 
The  child  of  affluent  and  intellectual  parents,  surrounded  by  all  that  is 
beautiful  in  nature  and  rich  in  art,  and  beloved  by  all  who  came  in 
contact  with  her,  her  heart  and  mind  developed  their  rare  qualities 
together. 

Under  the  guidance  of  her  father,  she  attained  considerable  proficien- 
cy in  the  classics,  and  in  mathematics  —  studies  which  are  rarely  pur- 
sued by  ladies  in  these  latter  days.  Nor  were  the  more  feminine  ac- 
complishments neglected  by  the  ardent  student.  She  became  an  excel- 
lent musician,  and  conversant  with  most  of  the  modern  languages, 
speaking  French,  Italian,  and  German  with  fluency  and  purity. 

During  the  course  of  her  studies  she  travelled  extensively,  visiting 
most  of  the  cities  of  Europe,  and  penetrating  even  to  the  remotest  cat- 
aract of  the  Nile.  While  in  Egypt,  it  is  said,  she  tended  the  sick 
Arabs  with  whom  she  came  in  contact,  and  frequently,  by  judicious 
counsel  and  advice,  rendered  them  important  services. 

The  favorite  home  of  Miss  Nightingale's  childhood  —  Lea  Hurst, 
Derbyshire  —  is  a  most  picturesque  and  romantic  spot.  The  quiet 
and  secluded  hamlet  of  Lea  abounds  in  lovely  scenery,  and  in  interest- 
ing historical  and  literary  associations.  Lea  Hurst  is  beautifully  situ- 
ated on  rising  ground,  "  in  one  of  the  most  charming  and  extensive  of 
the  Derbyshire  valleys,  and  surrounded  with  hills  and  mountains,  rocks 
and  woods,  of  majestic  and  gigantic  proportions,  and  watered  by  the 
■winding  Derwent  and  its  tributary  streams. " 

From  her  earliest  childhood,  Florence  Nightingale  displayed  a  con- 
stant and  active  sympathy  with  the  suffering,  the  desolate,  and  the  dis- 
tressed among  the  poor  around  Lea  Hurst  and  Embley.  As  a  friend, 
a  benefactress  and  a  consoler,  she  was  daily  welcomed  in  many  a  cot- 
tage ;  and  to  the  alleviation  of  pains  and  sorrows  she  devoted  her  per- 
sonal energies  and  her  large  fortune.  She  was  for  many  years,  as  a 
voluntary  teacher,  the  principal  support  of  the  schools  for  the  poor  ia 
the  neighboring  villages  ;  for  she  never  wearied  of  well-doing. 

1 


FLORENCE   NIGHTINGALE. 

Having  attained  the  age  when  yoimg  ladies  of  birth  and  fortune 
generally  "  come  out"  and  partake  of  the  brilliant  gayeties  of  society, 
riorence  Nightingale  visited  London,  But  it  was  for  the  purpose  of 
frequentmg  and  studying  the  hospitals,  schools  and  reformatory  insti- 
tutions of  the  metropolis,  a  self-imposed  duty,  which  she  performed 
with  untiring  energy  and  diligence.  Yet  she  did  not  neglect  to  fulfil 
the  more  immediate  duties  of  her  station  with  grace  and  propriety, 
even  to  a  presentation  at  Court ;  which  proved  that  she  was  not  one  of 
those  who  devote  themselves  to  the  cause  of  charity  in  order  to  avoid 
the  onerous  claims  of  social  life. 

From  London,  Florence  Nightingale  went  to  Edinburgh,  and  to  the 
Continent,  intent  on  perfecting  herself  for  a  high  and  holy  mission, 
and  gathering  up  stores  of  knowledge  for  present  as  well  as  for  future 
use.  In  the  memorable  year  1851,  when  all  Europe  held  festive  holi- 
day in  honor  of  the  Great  Exhibition,  when  ''the  highlands  of  Scot- 
land, the  lakes  of  Switzerland,  and  all  the  bright  spots  of  the  Conti- 
nent were  filled  with  parties  of  pleasure,"  Miss  Nightingale  —  so  well 
fitted  by  birth  and  education  to  shine  a  star  in  her  own  proper  sphere 
—  took  up  her  abode  in  a  hospital  at  Kaiserwerth  on  the  Rhine,  where 
Protestant  Sisters  of  Mercy  are  trained  as  nurses  for  the  sick ;  and  for 
three  long  months,  within  the  walls  of  this  institution,  she  remained 
in  daily  and  nightly  attendance,  unwearyingly  expending  her  health 
and  strength  in  the  cause  of  benevolence.  Here  she  made  herself 
thoroughly  acquainted  with  all  the  rules  and  regulations  required  in 
the  management  of  a  hospital.  The  Pasteur  Flieaner,  director  of  the 
establishment,  affirmed  that  during  the  progress  of  the  institution,  no 
one  had  ever  passed  so  distinguished  an  examination  or  shown  herself 
so  thoroughly  mistress  of  all  she  had  to  learn,  as  the  young,  wealthy, 
and  graceful  Englishwoman.  With  the  institution  she  was  so  favora- 
bly impressed  that  she  afterwards  returned  to  it,  and  subsequently  pub- 
lished a  little  book  containing  an  account  of  its  origin  and  manage- 
ment. 

From  Germany,  Miss  Nightingale  returned  to  the  happiness  of  home, 
the  love  of  her  parents  and  sister,  and  to  the  fresh,  free  air  of  Derby- 
shire and  Hampshire,  in  order  to  recruit  her  health.  13ut  her  sympa- 
thy and  energy  were  speedily  enlisted  on  behalf  of  the  Hospital  for 
Sick  Governesses,  established  in  Harley  Street,  London,  which  was 
languishing  for  want  of  proper  management  and  judicious  support. 
She  was  appealed  to  for  aid.  ^lost  young  and  wealthy  ladies  in  such 
a  case  would  have  given  a  handsome  donation  to  assist  the  institution. 
With  the  heroism  of  pure  benevolence  Florence  Nightingale  gave  — 
herself. 

She  took  the  active  and  entire  superintendence  of  the  Sanatorium, 
devoting  herself  with  indefatigable  energy  to  place  it  on  a  firm  basis. 
Derbyshire  and  Hampshire  were  exchanged  for  the  narrow,  dreary  es- 
tablishment in  Harley  Street,  to  which  she  devoted  all  her  time  and 
fortune.  "  While  her  friends  missed  her  at  assemblies,  lectures,  con- 
certs, exhibitions  and  all  the  entertainments  for  taste  and  intellect 
with  which  London,  in  its  season,  abounds,"  says  one  writer,  "she, 
whose  powers  could  have  best  appreciated  them,  was  sitting  beside  the 
bed,  and  soothing  the  last  complaints  of  some  poor,  dying,  homeless, 
querulous  governess.  The  homelessness  might,  not  improbably,  result 
from  that  very  quc-rulousness  ;  but  this  is  too  frequently  fomented,  if 
not  created,  by  the  hard,  unreflecting  folly  which  regards  fellow-crea- 
tures intrusted  with  forming  the  minds  and  dispositions  of  its  children 

ii 


FLORENCE  NIGHTINGALE. 

as  ingenious,  disagreeable  machines,  needing,  like  the  steam-engine, 
sustenance  and  covering,  but,  like  it,  quite  beyond  or  beneath  all  sym- 
pathy, passions,  or  affections.  Miss  Nightuigale  tiiought  otherwise, 
and  found  pleasure  in  tending  those  poor,  destitute  governesses,  in 
their  infirmities,  their  deaths,  or  their  recoveries.  She  was  seldom  seen 
outside  the  walls  of  the  institution,  and  the  few  friends  whom  she  ad- 
mitted found  her  in  the  midst  of  nurses,  letters,  prescriptions,  accounts, 
and  interruptions.  Her  health  sank  under  the  heavy  pressure,  but  a 
little  Hampshire  fresh  air  restored  her,  and  the  failing  institution  was 
saved. 

About  this  time,  1854,  Florence  Nightingale  also  took  an  active  in- 
terest in  the  Ragged  Training  Schools,  and  several  similar  institutions. 
She  felt,  with  Hannah  More,  that  "the  care  of  the  poor  is  the  profes- 
sion of  women,"  and  all  her  talents  were  unceasingly  employed  in  the 
amelioration  of  their  miseries. 

13ut  while  Miss  Nightingale  was  recruiting  her  health  and  spirits  in 
her  beautiful  home  at  Embley,  a  cry  of  dire  distress  and  bitterest  agony 
came  from  the  East,  piercing  England  nearly  to  the  heart.  It  arose 
from  our  wounded  brethren,  huddled  together,  languishing  in  their 
rough  beds,  destitute  of  comforts  or  even  necessary  accommodations, 
crushed  by  the  cold,  unfeeling,  iron  heel  of  Routine,  and  by  the  heavy, 
murderous  hand  of  Mismanagement.  An  enthusiastic  desire  to  re- 
spond to  it  instantly  sprang  up  in  the  breasts  of  all  who  heard  it ;  and 
suggestions  were  offered  from  all  quarters  by  warm  and  willing  hearts. 
Undisciplined  zeal,  however,  could  do  little  towards  supplying  the 
wants  of  those  dying  heroes  who  were  uttering  the  mournful  cry  for 
help  ;  and  it  was  feared  lest  the  ardent  feelings  which  had  been  roused 
might  flag  or  be  misdirected  for  lack  of  some  systematic  arrangement. 
Wealth  was  poured  forth  to  aid,  and  food,  clothing,  medicines,  and 
other  necessaries  were  shipped  in  abundance  ;  but  something  more  was 
needed.  A  proposition,  originated  by  Lady  Maria  Forester,  to  form  a 
band  of  female  nurses,  to  be  despatched  to  the  seat  of  war,  w^as  started, 
and  found  favor  with  the  government  and  the  majority  of  the  public. 

The  idea  being  propounded,  the  chief  difficulty  was  to  carry  it  out ; 
and  there  was  a  fear  "  lest  a  noble  impulse  should  fail  for  the  Avant  of 
a  head,  a  hand,  and  a  heart  to  direct  it."  But,  having  engaged  three 
nurses.  Lady  Maria  Forester  waited  on  Miss  Nightingale,  and  entreated 
her  to  take  the  direction  and  entire  control  of  the  nursing  establishment 
for  our  sick  and  wounded  soldiers  and  sailors  on  the  distant  shores  of 
the  Levant.  Lady  J*Iaria's  request,  earnestly  seconded  by  that  of  the 
Right  Hon.  Sidney  Herbert,  then  secretary-at-war,  induced  ^liss  Night- 
ingale to  yield  a  generous  consent  to  undertake  the  management  of  the 
expedition.  It  is,  indeed,  affirmed  by  some,  that,  by  a  strange  coinci- 
dence, the  noble  woman  had  herself  written  to  Mr.  Herbert  on  the 
very  same  day,  volunteering  her  services  where  they  were  so  direfully 
needed. 

Immediately  on  her  intention  becoming  known,  horror  thrilled  the 
souls  of  those  humane  and  wise  Gradgrinds  Avho,  comprehending  no 
•'  facts  "  but  those  which  had  undoubted  precedents,  had  lau<?hed  aloud 
when  Elizabeth  Fry  proposed  to  cleanse  Newgate,  and  had  coldly 
sneer  id  when  Hannah  More  hinted  at  Sunday  schools.  But,  upheld 
by  her  noble  and  compassionate  heart,  and  resolved  to  follow  humbly 
and  reverentially  in  the  footsteps  of  Oxe  who  had  suffered  from  evil 
tongues,  Florence  Nightingale  calmly  held  on  her  way  up  the  steep 
and  rocky  road,  nor  heeded  the  discordant  cries  which  would  have 
called  her  back. 

iii 


FLORENCE   NIGHTINGALE. 

Not  a  tnomcnt  was  lost  in  unnecessary  delay,  or  in  preliminary 
preparations.  Miss  Nightingale  formed,  from  some  hundreds  who 
offered,  a  band  of«thirty- seven  nurses  —  many  of  them,  like  herself, 
volunteers  from  the  higher  ranks  of  life,  gentle  ladies,  accustomed  to 
ease  and  luxury,  but  not  unused  to  tend  the  suffering  or  the  dying, 
nor  to  lead  lives  of  charity  and  self-denial.  Twelve  nuns  from  the 
Convent  at  Norwood,  under  charge  of  their  superioress,  an  Irish  lady, 
proffered  their  services,  and  were  gladly  included  in  the  noble  corps ; 
for  the  holy  leader  of  the  band  was  no  narrow-minded  bigot,  and  did 
not  doubt  but  that  a  basin  of  gruel,  a  glass  of  wine,  or  a  cup  of  med- 
icine, might  perhaps  be  administered  as  tenderly  by  a  hand  which 
claspejcl  a  missal  as  by  one  which  touched  a  Testament.  When  every 
thing  was  ready,  Florence  Nightingale  bade  farewell  to  her  fond  par- 
ents and  her  affectionate  sister,  renounced  her  friendships  and  her 
intellectual  pleasures,  and  quitted  the  comforts  of  her  home,  the  quiet 
liberty  of  dear  old  England,  for  a  perilous  journey  to  a  land  teeming 
with  danger  and  disease. 

She  and  her  sister-laborers,  prompted  by  the  most  sincere,  charit^le, 
and  religious  feelings  which  can  inspire  the  human  heart,  \id  fin- 
daunted  by  the  length  of  the  voyage,  the  strange  and  distant  cou  -itry 
before  them,  the  awful  scenes  they  would  encounter,  or  the  privations 
they  Avould  have  to  endure,  started  for  their  destination  on  Tuesday, 
the  24th  of  October,  1854.  Surely,  if  there  was  heroism  in  dashing 
up  the  heights  of  Alma,  seeking  glory  at  the  cannon's  mouth  in  defi- 
ance of  death  and  of  all  mortal  opposition,  amid  the  shouts  of  the  vic- 
tors and  the  cries  of  the  vanquished,  there  was  heroism  unparalleled 
in  calmly  volunteering  to  minister  to  the  fever-stricken  and  the  dying 
in  a  place  reeking  with  deadly  disease  and  polluted  air,  where  '*  wounds 
almost  refused  to  heal,  and  M'here  the  heavy  smell  of  pestilence  could 
be  perceived  outside  the  very  walls,"  and  surrounded  by  sights  and 
sounds  calculated  to  appall  the  stoutest  hearts. 

They  were  accompanied  by  Mr.  and  !Mrs.  Bracebridge,  a  clergyman, 
and  a  courier.  On  their  arrival  at  Boulogne,  the  self-devoted  band 
was  hailed  with  demonstrations  of  sympathy  and  respect  by  a  crowd 
which  assembled  to  welcome  them  on  their  way,  and  bid  them  "  God 
speed."  In  passing  through  France,  they  were  received  with  the  utmost 
enthusiasm  ;  hotel-keepers  refusing  payment  for  their  accommodation, 
servants  declining  the  customary  fees,  all  emulating  to  evince  achnira- 
tion  and  sympathy.  One  of  the  Paris  journals,  on  Miss  Nightmgale's 
passing  through  the  French  metropolis,  observed  of  her  that  "her  toi- 
lette was  charming,  and  she  was  almost  as  graceful  as  a  Parisienne." 
On  the  27th,  they  sailed  from  Marseilles,  in  the  Vectis  steamer,  for 
Constantinople. 

On  the  oth  of  November,  Miss  Nightingale,  accompanied  by  Mr. 
and  Mrs,  Bracebridge,  and  her  nurses,  arrived  at  Constantinople  ;  and 
the  whole  party  was  speedily  established  at  their  new  quarters  in  the 
Barrack  Hospital  at  Scutari.  This  was  a  handsome  building,  capable 
of  holding  an  immense  number  of  soldiers  ;  the  court-yard  alone  being 
sufficiently  large  to  afford  space  for  exercising  twelve  thousand  men, 
and  the  corridors,  running  the  whole  length  of  the  barrack,  being  esti- 
mated to  comprise  four  miles  in  extent.  On  three  sides  of  the  building 
were  galleries,  in  which  were  ranged  in  double  rows  the  beds  of  the 
patients.  Five  rooms,  which  had  been  set  apart  for  wounded  general 
officers,  were  happily  vacant ;  and  these  were  assigned  to  Miss  Night- 
ingale and  her  friends. 


FLORENCE  NIGHTINGALE. 

The  appearance  of  the  delicate,  tender,  thoughtful  nurses  was  hailed 
with  delight  and  raptures  of  gratitude  by  the  objects  of  their  sympathy 
and  devotion.  One  poor  fellow  burst  into  tears,  and  exclaimed,  "I 
can't  help  crying  when  I  see  them.  Only  think  of  Englishwomen 
coming  out  here  to  nurse  us  ;  it  is  so  homely  and  comfortable  !  "  The 
heavy  cares  and  duties  which  awaited  them  were  terribly  increased, 
within  a  few  hours  of  their  coming,  by  the  arrival  of  six  hundred 
wounded,  sent  down  after  the  battle  of  Inkerman.  The  over- worked 
surgeons,  "one  and  all,"  acknowledged  that  their  services,  at  such  a 
juncture,  were  invaluable;  even  the  most  <*  hard-headed  old  Scotch 
"-  ,  geons,"  whom  some  of  the  croakers  had  feared  would  be  constantly 
resenting  raps  from  the  scented  fan  of  Miss  Nightingale,  admitted  that 
the  tender  nurses  ♦'  were  not  in  the  way  except  to  do  good." 

"Miss  Nightingale,"  says  one  letter,  in  November,  "appears  emi- 
nently qualified  for  the  noble  work  she  has  undertaken.  Her  labors 
will  spare  the  clergy  many  a  sad  sight  of  men  sinking  for  want  of 
proper  nursing,  and  because  food  cannot  be  administered  often  enough. 
This  is  impossible,  with  only  the  hospital  orderlies  ;  but  with  the 
nurses,  all  who  need  will  be  supplied."  But  food,  clothing,  medicines, 
and  extra  medical  aid  were  wanting ;  and  the  men  were  constantly 
sinking  through  exhaustion,  when,  if  it  had  been  at  hand,  a  timely 
stir  ulant  administered  might  have  saved  them. 

Linen,  flannels,  stockings,  and  other  necessary  articles  of  clothing, 
were  not  to  be  obtained  ;  the  vast  freights  which  had  hcen  sent  from 
England  were  either  rotting  under  the  snow  at  Balaklava,  or  hidden  in 
the  mud  outside  the  custom-house  at  Constantmople.  The  strength 
with  which  Miss  Nightingale  supported  the  difficulties  and  duties  of 
her  position  surpassed  even  the  expectations  of  those  who  were  best 
acquainted  with  her  character  and  the  resources  of  her  nature.  Every 
day  brought  some  new  complication  of  misery  to  be  unravelled.  "  Each 
day,"  observes  a  qualified  witness,  "  had  its  own  peculiar  trial  to  one 
who  had  taken  such  a  load  of  responsibility  in  an  untried  field,  and 
with  a  staff  of  her  own  sex  all  new  to  it.  She  has  frequently  been 
known  to  stand  twenty  hours,  on  the  arrival  of  fresh  detachments  of 
sick,  apportioning  quarters,  distributing  stores,  directing  the  labors  of 
her  corps,  assisting  at  the  most  painful  operations  where  her  presence 
might  soothe  or  support,  and  spending  hours  over  men  dying  of  chol- 
era or  fever.  Indeed,  the  more  awful  to  every  sense  any  particular 
case  might  be,  the  more  certainly  might  be  seen  her  slight  form  bending 
over  him,  administering  to  his  ease  by  every  means  in  her  power,  and 
seldom  quitting  his  side  until  death  released  him." 

Yet  the  difficulties  of  Florence  Nightingale's  position  were  increased 
tenfold  by  the  continual  struggles  which  she  was  obliged  to  undergo 
with  System  and  the  prejudices  of  individuals.  By  petty,  daily  con- 
tests, she  was  compelled  to  extort  from  the  authorities  a  scanty  allow- 
ance of  the  necessary  materials  required  by  her  and  her  band  of  nurses. 
Etiquette  and  "service"  regulations  impeded  her  movements  at  every 
step;  "indolence,  indifference,  and  hicapacity  "  combined  to  clog  her 
exertions;  for  "no  one  would  take  'responsibility'  upon  himself, 
even  to  save  the  lives  of  hundreds."  Happily,  the  presence  and  able  co- 
operation of  Mr.  Macdonald,  the  distributor  of  "  The  Times  Fund," 
enabled  her  at  length  to  lay  in  stores,  to  institute  proper  culinary  and 
washing  departments,  and  to  introduce  some  order  and  comfort.  Had 
it  not  been  for  their  mutual  exertions,  a  large  proportion  of  the  poor 
prostrate  sufferers  must  have  been  condemned  to  wear  the  tattered, 

V 


FLORENCE   NIGHTINGALE. 

filtiiV  rags,  in  -which  they  Avere  brought  down  from  the  Crimea.  A 
washing  contract  had,  it  is  true,  existed  ;  but  it  -was  totally  inoperative, 
and  the  beds  and  habiliments  of  the  men  had  been  in  a  condition  loath- 
some and  fold  beyond  description.  A  house,  well  supplied  with  water, 
close  to  the  Barrack  Hospital,  was  engaged  at  the  charge  of  the  fund, 
and  here  the  clothing  supplied  by  Miss  Nightingale  was  washed  and 
dried.  In  ten  days  after  her  arrival  an  impromptu  kitchen  was  fitted 
up,  from  Avhich  eight  hundred  men  were  daily  supplied  with  well- 
cooked  food  and  other  necessary  culinary  comforts  in  abundance  — 
beef-tea,  chicken-broth,  rice-pudding,  jelly,  chickens,  and  numerous 
delicacies.  Heretofore  the  cookery,  performed  by  soldiers,  without 
any  superintendence,  and  of  course  without  any  system,  had  been  most 
detestable,  when  the  sickly,  fastidious  appetite  of  a  fevered  or  consump- 
tive patient  is  considered.  Meat  and  vegetables  had  been  boiled  in 
one  large  copper,  the  separate  portions  enclosed  in  nets,  and  served  up 
either  done  to  rags  or  half  raw  ;  and  the  delivery  had  been  as  devoid 
of  system  as  the  cookery.  Sometimes  it  would  be  six  or  seven  o'clock 
in  the  evening  before,  in  individual  cases,  things  ordered  could  be  sup- 
plied, and  then  the  means  of  cooking  would  be  at  an  end.  In  subor- 
dinate as  well  as  in  leading  points  of  arrangement,  the  same  feminine, 
directing  hand  was  now  to  be  traced. 

With  rare  thoughtfulness,  the  nurses  were  employed  in  making  up 
needful  articles  of  bedding  or  surgical  requisites,  stump  pillows  for 
amputation  cases,  and  other  things  of  a  like  nature. 

One  "rule  of  the  ser\ice"  was  in  existence  which  alone  exemplifies 
the  system  bearing  so  heavily  upon  the  helpless  mvalids,  and  which  it 
required  all  the  tact  and  firmness  of  Miss  Nightingale  to  stand  against ; 
it  demanded  that  all  articles  needed  even  for  present  use  should  be 
procured  from  home  through  the  commissariat ;  and  there  was  likewise 
a  regulation  appointing  that  a  "board"  must  judge  stores  already 
landed,  before  they  could  be  given  out.  On  one  occasion,  the  "board" 
not  having  completed  its  arrangements,  and  the  men  languishing  for 
the  stores  sent  from  England,  Miss  Nightingale  insisted  that  they 
should  be  at  once  dispensed.  Red  Tape,  shocked  at  the  audacity  of 
such  a  singular  proposition,  interposed ;  woe  betide  the  man  amenable 
to  martial  law  who  should  dare  to  touch  even  the  cordage  of  one  box  ! 
The  noble-spirited  woman,  conscious  that  determination  must  effect 
what  entreaty  had  failed  to  do,  had  the  store-house  broken  open,  on 
her  own  responsibility,  and  its  contents  distributed  through  their 
proper  channels.  But,  on  all  other  occasions,  she  paid  the  most  scru- 
pulous deference  to  the  existing  laws.  Her  name  and  angelic  minis- 
terings  Avere  the  theme  of  frequent  grateful  praise  among  the  men  in 
the  trenches ;  and  it  was  remarked  that  she  made  the  Barrack  Hospital 
so  comfortable,  that  the  convalescents  began  to  display  a  decided  re- 
luctance to  leave  it. 

Not  only  in  the  scene  of  her  arduous  labors,  but  at  home,  was  the 
self- dedicated  Samaritan  assailed  by  jealousies  and  suspicions.  The 
circumstance  of  her  having  accepted  the  services  of  some  Sisters  of 
Charity  from  the  nunnery  at  Norwood,  and  from  St.  Stephen's  Hospi- 
tal, Dublin,  drew  down  upon  her,  in  December,  so  invidious  an  attack 
from  a  clergyman  of  the  Established  Church,  that  the  Hon  ]SIrs.  Sidney 
Herbert  was'  obliged  to  step  forward  and  defend  her  absent  friend,  and 
show  "  how  cruel  and  unjust"  were  the  aspersions  thrown  upon  her. 

"It  is  melancholy  to  think,"  she  wrote  to  the  wife  of  the  Rev.  gen- 
tleman, "  that  in  England  no  one  can  undertake  any  thing  without  the 

vi 


FLORENCE  NIGHTINGALE. 

most  tincharitable  and  sectarian  attacks ;  and,  had  you  not  told  me,  I 
should  scarcely  have  believed  that  a  clergyman  of  the  Established 
Church  would  have  been  the  mouthpiece  of  slander.  Miss  Nightingale 
is  a  member  of  the  Established  Church  of  England,  and  what  is  called 
rather  Low  Church." 

The  Hon.  and  Rev.  Sydney  Godolphin  Osborne  adds  his  testimony 
to  the  pure  religion  of  the  object  of  these  animadversions  :  "  I  found 
her  myself  to  be,  in  her  every  word  and  action,  a  Christian  ;  I  thought 
this  quite  enough.  It  would  have  been,  in  my  opinion,  the  most  cruel 
impertinence  to  scrutinize  her  words  and  acts  to  discover  to  which  of 
the  many  bodies  of  true  Christians  she  belonged.  I  have  conversed 
•with  her  several  times  on  the  deaths  of  those  whom  I  had  \'isited  min- 
isterially in  the  hospitals,  with  whom  she  had  been  when  they  died.  I 
never  heard  one  word  from  her  lips  that  would  not  have  been  just  what 
I  should  have  expected  from  the  lips  of  those  whom  I  have  known  to 
be  the  most  experienced  and  devout  of  our  common  faith.  Her  work 
ought  to  answer  for  her  faith ;  at  least,  none  should  dare  to  call  that 
faith  in  question,  in  opposition  to  such  w^ork,  on  grounds  so  weak  and 
trivial  as  those  I  have  seen  urged.  ...  If  there  is  blame  in  look- 
ing for  a  Roman  Catholic  priest  to  attend  a  dying  Romanist,  let  me 
share  it  with  her  —  I  did  it  again  and  again." 

Early  in  January,  1855,  the  executive  strength  at  Miss  Nightingale's 
disposal  was  increased  by  the  arrival  of  Miss  Stanley,  with  fifty  more 
nurses,  who  were  terribly  needed,  for  there  were  then  on  the  Bospho- 
rus  and  Dardanelles  no  less  than  eight  hospitals,  containing  an  aggre- 
gate of  nearly  five  thousand  sick  and  wounded,  while  there  were  eleven 
hundred  more  on  their  way  from  the  Crimea.  In  the  Barrack  Hospi- 
tal alone  there  were  about  three  thousand  patients,  all  of  them  severe 
cases. 

But  as  Florence  Nightingale  was  struggling  against  the  disgraceful 
jealousy  of  hospital  officials,  her  heart  was  cheered  and  encouraged  by 
a  glorious  letter,  filled  with  true  English  warmth  and  sjTnpathy,  writ- 
ten by  Queen  Victoria —  "not  a  letter  stifi"  with  gold  thread  and  glit- 
tering with  gems,"  but  womanly  and  queen-like,  '*  with  nothing  of  the 
ermine  about  it  but  its  softness  and  purity." 

"  Would  you  tell  Mrs.  Herbert,"  wrote  the  Queen  of  England  to 
^Ir.  Sidney  Herbert,  "  that  I  beg  she  would  let  me  see  frequently  the 
accounts  she  receives  from  Miss  Nightingale  or  Mrs.  Bracebridge  ;  as 
I  hear  no  details  of  the  wounded,  though  I  see  so  many  from  officers, 
&c.,  about  the  battle-field,  and  naturally  the  former  must  interest  me 
more  than  any  one.  Let  Mrs.  Herbert  also  know  that  I  wish  ^liss 
Nightingale  and  the  ladies  would  tell  these  poor,  noble,  wounded  and 
sick  men  that  no  one  takes  a  warmer  interest,  or  feels  more  for  their 
sufferings,  or  admires  their  courage  and  heroism  more  than  their  Queen. 
Day  and  night  she  thinks  of  her  beloved  troops.  So  does  the  Prince. 
Beg  Mrs.  Herbert  to  communicate  these  my  words  to  those  ladies,  as 
I  know  that  our  sympathy  is  much  valued  by  these  noble  fellows." 

It  is  easy  to  imagine  that  this  letter,  so  gracious,  kind,  and  tender, 
must  have  strengthened  the  heart  of  the  noble  Florence  Nightingale  in 
her  arduous  work.  Touching  and  simple,  those  words  of  sympathy, 
"  spoken  right  nobly  as  a  queen,  right  affectionately  as  a  mother,  right 
eloquently  as  a  woman,"  are  worth  a  thousand  times  the  brave  speech- 
es or  heroism  of  any  of  the  queens  of  "  the  jewel  set  in  a  golden  sea." 
But  Her  Majesty  has  proved  by  many  good  deeds  that  she  can  feci  for 
suffering  and  want,  and  has  always  evinced  more  especially  a  strong 

vii 


FLORENCE  NIGHTINGALE. 

interest  in  her  wounded  or  disabled  soldiers,  visiting  and  cheering 
them  on  many  occasions. 

By  February,  the  great  increase  of  fever  was  the  chief  point  of  re- 
mark ;  it  raged  destructively,  and  in  less  than  a  month  it  swept  away 
no  fewer  than  seven  surgeons,  leaving  eight  more,  and  three  of  the 
nurses,  dangerously  ill.  Indeed,  at  that  time  there  was  but  one  medi- 
cal attendant  well  enough  to  wait  on  the  sick  in  the  Barrack  Hospital ; 
and  his  services  were  required  in  no  less  than  twenty-one  wards.  Drs. 
Newton  and  Struthers  were  tended  in  their  last  moments,  and  had  their 
dying  eyes  closed,  by  Miss  Nightingale.  For  "wherever  there  is  dis- 
ease in  its  most  dangerous  form,"  Avrote  Mr.  Macdonald,  in  February, 
"and  the  hand  of  the  despoiler  distressingly  nigh,  there  is  that  incom- 
parable woman  sure  to  be  seen  ;  her  benignant  presence  is  an  influence 
for  good  comfort,  even  amid  the  struggles  of  expiring  nature.  She  is 
« a  ministering  angel,'  without  any  exaggeration,  in  these  hospitals ; 
and,  as  her  slender  form  glides  quietly  along  each  corridor,  every  poor 
fellow's  face  softens  with  gratitude  at  the  sight  of  her.  "S\Tien  all  the 
medical  officers  have  retired  for  the  night,  and  silence  and  darkness 
have  settled  down  upon  those  miles  of  prostrate  sick,  she  may  be  ob- 
served alone,  with  a  little  lamp  in  her  hand,  making  her  solitary 
rounds.  The  popular  instinct  was  not  mistaken  which,  when  she  set 
out  from  England  on  her  mission  of  mercy,  hailed  her  as  a  heroine  ;  I 
trust  that  she  may  not  earn  her  title  to  a  higher,  though  sadder,  appel- 
lation. No  one  who  has  observed  her  fragile  figiu-e  and  delicate  health 
can  avoid  misgivmgs  lest  she  should  fail.  With  the  heart  of  a  true 
woman,  and  the  manners  of  a  lady,  accomplished  and  refined  beyond 
most  of  her  sex,  she  combines  a  surprising  calmness  of  judgment  with 
promptitude  and  decision  of  character." 

Of  the  sublime  courage  which  must  have  supported  her  during  these 
solitary  nocturnal  rounds  we  may  judge  by  the  slight  sketch  given  in 
another  place.  Speaking  of  the  frightful  and  sickening  sounds  and 
sights  in  the  wards  and  corridors,  he  says  :  "  Duruag  the  day  little  of 
this  is  heard ;  but  when  all  is  silent,  and  sleep  has  settled  down  upon 
the  occupants  of  each  ward  and  corridor,  then  rise  at  intervals  upon 
the  ear  sounds  which  go  straight  to  the  heart  of  the  listener." 

Merely  to  see  her  pass  along  was  an  inexpressible  comfort  to  the 
men.  "She  would  speak  to  one,"  said  a  poor  fellow,  writing  home, 
"  and  nod  and  smile  to  a  many  more ;  but  she  couldn't  do  it  to  all, 
you  know.  "We  lay  there  by  hundreds  ;  but  we  could  kiss  her  shadow 
as  it  fell,  and  lay  our  heads  on  the  pillow  again,  content."  In  her 
rounds,  to  one  she  would  administer  words  of  consolation  and  hope,  to 
another  teach  resignation,  now  cheering  with  a  smile  or  sjTupathizing 
with  a  sigh  —  ministering  to  the  necessities  both  of  mind  and  body  of 
the  sufferers,  who,  following  her  light,  soft  footsteps  with  their  tear- 
brimmed  eyes,  bent  to  "kiss  her  shadow  as  it  fell."  Such  was  her 
uifluence,  that  when  men,  frenzied  by  their  wounds  and  disease,  had 
worked  themselves  into  a  passionate  refusal  to  submit  to  necessary  op- 
erations, a  few  calm  sentences  of  hers  seemed  at  once  to  allay  the 
storm  ;  and  the  men  would  submit  willingly  to  the  painful  ordeal  they 
had  to  undergo. 

Of  Florence  Nightingale's  personal  appearance  the  author  of  "  Scu- 
tari and  its  Hospitals  "  gives  a  most  interesting  description.  "Miss 
Nightingale,"  he  says,  "  is  jvist  what  you  would  expect  in  any  other 
well-bred  woman,  who  may  have  seen,  perhaps,  rather  more  than 
thirty  years  of  life  ;   her  manner  and  countenance  are  prepossessing, 

viii 


FLORENCE  NIGHTINGALE. 

and  this  without  the  possession  of  positive  beauty ;  it  is  a  face  not 
easily  forgotten,  —  pleasing  in  its  smile,  with  an  eye  betokening  great 
self-possession,  and  giving,  when  she  wishes,  a  quiet  look  of  tirm  deter- 
mination to  every  feature.  Her  general  demeanor  is  quiet,  and  rather 
reserved  ;  still,  I  am  much  mistaken  if  she  is  not  gifted  with  a  very 
lively  sense  of  the  ridiculous.  In  conversation,  she  speaks  on  matters 
of  business  with  a  grave  earnestness  I  should  not  expect  from  her 
appearance.  She  has  evidently  a  mind  disciplined  to  restrain,  under 
the  principles  of  the  action  of  the  moment,  every  feeling  which  would 
interfere  with  it.  She  has  trained  herself  to  command,  and  learned 
the  value  of  conciliation  towards  others,  and  constraint  over  herself. 
She  seems  to  xmderstand  business  thoroughly.  Her  nerve  is  won- 
derful. I  have  been  with  her  at  very  severe  operations  ;  she  was  more 
than  equal  to  the  trial." 

In  April  ^Miss  Nightingale  lost  a  very  dear  personal  friend,  one  of 
the  nurses,  a  young  and  amiable  lady  named  Miss  Sniythc.  This  lady 
had  commenced  her  occupation  as  nurse  at  Scutari,  but,  being  re- 
quested to  join  ]Miss  Bracebridge  at  Kululee,  —  which  was  on  the 
Asiatic  side  of  the  Bosphorus,  five  miles  from  Scutari,  —  she  left  for 
that  place,  much  regretted  by  Miss  Nightingale,  who  said  she  hoped 
that  they  would  have  labored  together  in  the  same  hospital.  Shortly 
after  her  arrival  she  was  attacked  by  fever,  and  died  deeply  mourned. 

Miss  Nightingale's  firm,  systematic,  and  energetic  thoughtfulness  at 
length  gained  its  w^ay,  and  she  had  the  satisfaction  of  seeing  that  the 
most  important  part  of  her  work  at  Scutari  w^as  accomplished.  She 
accordingly  repaired  to  Balaklava,  with  the  view  of  inspecting  its  hos- 
pitals, arriving  there  May  4,  1855.  There  she  examined  the  general 
state  of  aff'airs,  had  new  huts  erected,  kitchens  built,  and  vigorous 
organization  instituted  ;  but  no  sooner  were  all  these  matters  arranged 
than  the  long- continued  arduous  exertions  which  she  had  undergone 
told  on  her  system.  Her  delicate  and  fragile  fiame  was  attacked  by 
Crimean  fever  ;  and,  completely  prostrated,  she  was  carried  up  to  the 
hut-hospital  on  the  heights. 

For  a  fortnight  the  fever  continued  its  hold  ;  but  at  the  end  of  that 
time  Florence  Nightingale  rose,  weak,  yet  pronounced  out  of  danger, 
from  her  sick  bed.  She  was  earnestly  entreated  to  return  to  England ; 
but  no  persuasion  could  induce  her  to  quit  her  post,  or  to  proceed 
further  than  Scutari.  Too  well  she  knew  that  her  presence  on  that 
sad  spot  was  still  urgently  needed.  She  left  Balaklava  for  Scutari, 
June  6  ;  Lord  Ward  placing  his  steam  yacht  at  her  disposal,  that  she 
might  have  the  advantage  of  change  of  air  in  sea  excursions  to  recruit 
her  strength.  So  exhausted  was  she  that  she  had  to  be  carried  down 
to  the  vessel,  tenderly  and  reverently  in  the  arms  of  the  men,  amidst 
their  heartfelt  prayers  for  her  speedy  recovery. 

Miss  Nightingale's  efforts  for  the  poor  fellows  in  the  hospitals  did 
not  terminate  with  their  death  ;  for  on  her  return  to  Scutari  she 
originated  a  scheme  for  erecting  a  monument  to  the  brave  men  who 
had  died  during  the  winter.  This  memorial  has  been  only  recently 
completed,  and  now  towers  in  gloomy  grandeur  above  the  surrounding 
graves  of  our  British  heroes.  It  is  simple  and  massive  ;  a  square  base, 
surmounted  by  four  figures  of  angcLs  with  drooping  wings,  who  sup- 
port a  tapering  shaft,  which  rises  towards  the  sky.  In  four  difi'erent 
languages  on  each  side  of  the  base  is  this  inscription  :  — 

"This  Monument  was  erected  by  Queen  Victokia  and  iier 

People." 

ix 


FLORENCE  NIGHTINGALE. 

By  December,  1855,  the  greater  number  of  the  hospitals  were 
closed  ;  the  Barrack  Hospital  was  again  used  for  its  original  purpose  ; 
and  all  seemed  hopeful  and  invigorated.  Her  Majesty,  to  mark  her 
warm  appreciation  of  the  inestimable  services  of  Miss  Nightingale, 
presented  her  with  a  beautiful  ornament,  adapted  to  be  worn  as  a 
decoration  of  the  most  elegant  and  costly  description.  It  was  formed 
of  a  St.  George's  Cross,  in  ruby-red  enamel,  on  a  white  field,  repre- 
senting England  ;  this  was  encircled  by  a  black  band,  typifying  the 
office  of  charity,  on  which  was  inscribed  the  legend,  "Blessed  are  the 
merciful."  Tlie  letters  V.  R.,  surmounted  by  a  crown  in  diamonds, 
were  impressed  upon  the  centre  of  the  St.  George's  Cross,  from  which 
emanated  rays  of  gold.  Y/ide- spreading  branches  of  palm,  in  bright- 
green  enamel,  tipped  with  gold,  composed  a  framework  for  the  shield, 
their  stems  being  banded  with  a  ribbon  of  blue  enamel,  inscribed  with, 
the  word  "■Crimea."  At  the  top  three  brilliant  stars  of  diamonds 
illustrated  the  idea  of  the  light  of  heaven  shed  upon  labors  of  mercy, 
peace,  and  charity.  On  the  back  of  the  jewel  there  was  an  inscription 
written  by  Her  Majesty,  recording  it  to  be  a  gift  in  memory  of  services 
rendered  to  her  brave  army  by  ^Nliss  Nightingale.  The  ornament  Avas 
about  three  inches  in  depth  by  two  and  a  half  in  width.  This  gift  was 
accompanied  by  an  autograph  letter  full  of  deep  feeling,  and  graceful, 
queenly  kindness. 

The  sultan  also  presented  !Miss  Nightingale  with  a  superb  bracelet, 
set  in  brilliants,  as  "a  mark  of  his  estimation  of  her  devotion." 

At  the  close  of  1855  it  was  resolved  that  an  acceptable  testimonial 
of  public  gratitude  should  be  offered  to  the  generous  Florence  Night- 
ingale ;  and  a  "  Nightingale  fund "  was  immediately  raised.  But, 
as  the  noble-hearted  woman  distinctly  declined  any  purely  personal 
reward  for  her  efforts,  a  resolution  was  passed  at  a  meeting  held  in 
Willis's  Rooms,  in  December,  that  the  fund  raised  should  be  invested 
to  establish  "an  institute  for  training,  sustenance,  and  protection  of 
nurses  and  hospital  attendants,"  to  embrace  the  paid  and  the  unpaid, 
for  whom  a  home  was  to  be  provided,  and  a  retreat  for  old  age. 
Numerous  meetings  were  held,  over  some  of  which  presided  a  prince 
of  the  blood  royal,  who  had  been  a  witness  of  Miss  Nightingale's 
labors  in  the  East,  and  which  were  attended  by  men  of  the  highest 
and  noblest  reputation.  One  important  meeting  was  held  at  the  Man- 
sion House,  December  26,  at  which  the  lord  mayor  presided,  and  at 
which  the  names  of  many  of  the  most  influential  merchants,  traders, 
and  manufacturers  were  announced  as  ha-\dng  consented  to  become 
members  of  a  committee.  A  copy  of  the  proceedings  of  the  meeting 
at  "Willis's  Rooms  was  sent  .out  to  Miss  Nightingale  ;  to  this  she  re- 
turned, in  January,  1856,  a  letter  most  characteristic  of  her  firm, 
practical,  and  yet  gracious,  kindly  disposition.  "Exposed  as  I  am," 
she  says,  "to  be  misinterpreted  and  misunderstood,  in  a  field  of  action 
in  which  the  work  is  new,  complicated,  and  distant  from  many  who 
sit  in  judgment  on  it,  it  is,  indeed,  an  abiding  sixpport  to  have  such 
sympathy  and  such  appreciation  brought  home  to  me  in  the  midst  of 
labors  and  difficulties  all  but  overpowering.  I  must  add,  however, 
that  my  present  work  is  such  as  I  would  never  desert  for  any  other, 
so  long  as  I  see  room  to  believe  that  what  1  may  do  here  is  unfinished. 
May  I,  then,  beg  you  (Mrs.  Herbert)  to  express  to  the  committee  that 
I  accept  their  proposal,  provided  I  may  do  so  on  their  understanding 
of  this  great  uncertainty,  as  to  when  it  will  be  possible  for  me  to  carry 
it  out."     This  gift  of  gratitude  was,  in  very  truth,  but  giving  its  recip- 

X 


FLORENCE   NIGHTINGALE. 

lent  more  -work  to  execute;  jet,  as  her  friend  Mr.  Sidney  Herbert 
observed,  "  Miss  Nighting-ale  looks  to  her  reward  from  this  country  in 
having  a  fresh  field  for  her  labors,  and  means  of  extending  the  good 
that  she  has  already  begun,  A  compliment  cannot  be  paid  dearer  to 
her  heart  than  in  givmg  her  more  -work  to  do." 

In  ^larch,  1856,  !Miss  Nightingale  sustained  a  slight  injury  from 
the  upsetting  of  a  vehicle,  in  which,  with  some  of  the  nurses,  she  was 
proceeding  up  to  the  fi-ont  of  Balaklava.  Her  back  being  hurt,  she 
was  obliged  to  remain  for  a  short  time  in  the  Castle  Hospital,  which 
had  been  erected  during  the  summer  of  1855,  in  a  lonely  but  healthy 
spot  at  the  mouth  of  Balaklava  Harbor.  During  the  spring,  despite 
her  anxieties  and  responsibilities,  she  found  time  to  attend  to  different 
minor  affairs  ;  through  her  exertions,  *'  a  considerable  quantity  of  school 
materials,  such  as  maps  and  slates,  was  supplied  to  the  schools ;  "  she 
advanced  on  her  own  respond- ibility  a  sufficient  sum  from  *'  T/ie  limes' 
Fund  "  to  complete  the  erection  of  the  Inkerman  Cafe  ;  she  aided  the 
active  senior  chaplain  in  establishing  a  library  and  schoolroom,  and 
warmly  assisted  him  in  organizing  evening  lectures  for  the  men.  She 
took  a  kindly  interest  in  the  private  affairs  of  the  men,  and  forwarded 
their  savings  to  their  families  in  England,  at  a  time  when  there  was  no 
provision  for  sending  home  small  sums  ;  she  wrote  letters  for  the  sick  ; 
she  studied  the  comforts  of  those  who  were  convalescent ;  and  from 
the  dying  she  took  charge  of  bequests.  She  had  a  tent  constructed,  to 
protect  from  the  glaring  heat  of  an  eastern  sun  the  invalids  who  were 
permitted  to  enjoy  the  air,  and  endured  the  mortification  of  a  refusal, 
from  the  hospital  authorities,  to  have  the  tent  put  up. 

M.  Alexis  Soyer,  in  his  "  Culinary  Campaign,"  relates  the  follo\A-ing 
interestmg  incident :  — 

"  Before  leaving  the  batterj^  I  begged  ISIiss  Nightingale,  as  a  favor, 
to  give  me  her  hand,  which  she  did.  I  then  requested  her  to  ascend 
the  stone  rampart  next  the  w^ooden  gun  carriage,  and  lastly  to  sit  upon 
the  centre  mortar,  to  which  requests  she  very  gracefully  and  kindly 
acceded.  I  then  boldly  exclaimed,  *  Gentlemen,  behoW  this  amiable 
lady  sitting  fearlessly  upon  that  terrible  instrument  of  war.  Behold 
the  heroic  daughter  of  England,  the  soldier's  fiiend  ! '  All  present 
shouted,  '  Bravo  !  bravo  !  Hurrah  I  hurrah !  Long  live  the  daughter 
of  England  ! '  " 

At  length  Florence  Nightingale's  holy  work  of  Christian  charity 
■was  accomplished,*  and  she  prepared  to  return  to  England.  The  period 
of  this  event  was  kept  a  profound  secret,  for  she  ever  carefully  shunned 
publicity  ;  and,  desirous  of  maintaining  the  strictest  incognito,  she 
declined  the  offer  of  a  passage  in  a  British  man-of-war,  and  embarked 
on  board  a  French  vessel.  Passing  through  France  by  night,  and 
travellhig  her  own  country  unrecognized,  she  quietly  arrived  at  Lea 
Hurst,  Derbyshire,  Friday,  August  15,  1856.* 

In  October,  Her  Majesty  invited  her  to  visit  the  royal  residence  at 
Balmoral ;  and,  at  a  ball  given  there,  she  was  seated  wdth  the  royal 
family  and  the  court  circle  at  one  end  of  the  hall.  On  this  occasion, 
it  was  noticed  that  her  hair,  which  the  severe  attack  of  illness  she  had 
suffered  in  the  Crimea  necessitated  cutting  off,  was  "  quite  short,"  but 
a  charming  little  cap  made  a  very  graceful  head-dress. 

*  It  is  deeply  interesting  to  Icaru  that  tlio  apartments  in  the  poiithern  tower 
of  the  IJarrack  Hospital,  formerly  occupied  by  Miss  iN'ighting^ale,  uow  remain, 
even  as  regards  the  furniture  they  contain,  precisely  as  they  were  during-  her 
residence  there ;  a  touching  relic,  which  we  owe  either  to  our  late  ambassador, 
I/Pr4  Stratford,  or  to  his  successor,  Sir  Henry  Bulwer. 

xi 


FLORENCE   NIGHTINGALE. 

A  subscription  being  raised  by  the  ^A-orkingmen  of  Sheffield  to  erect 
a  monninent  in  that  town  to  the  memory  of  their  countrymen  who  liad 
falk-n  in  tlie  Crimea,  a  request  was  made,  in  October,  to  Miss  Night- 
ingale, througli  her  relative  Miss  Shore,  of  Meersbrook  Hall,  that  she 
Avould  consent  to  lay  the  foundation  stone.  Miss  Nightingale,  in  re- 
fusing, sent  a  check  for  twenty  pounds  towards  the  object  proposed, 
but  said,  "  It  is  with  real  pain  that  I  feel  compelled  to  decline  the  priv- 
ilege, -which  they  offer  me,  of  laying  the  first  stone  ;  but  I  believe  I 
shall  best  honor  the  cause  of  those  brave  dead  by  abstaining  from  ap- 
pearing to  court  that  publicity  which  I  consider  to  have  been  my  great- 
est impediment  in  the  work  I  have  engaged  in  for  their  sakes  —  imped- 
ing it  by  arousing  in  some  minds  a  care  for  worldly  distinctions." 

As  an  instance  of  her  large-hearted  benevolence,  we  may  cite  an  in- 
cident which  occurred  on  her  return.  In  France  there  exists  a  chari- 
table institution, —  the  "  OEuvre  de  Notre  Dame  D'Orient," — under 
the  direction  of  I'Abbe  Legendre,  almoner  of  the  hospital  of  Bour- 
bonne-les-bains,  a  town  to  which  large  numbers  of  military  men  resort 
annually  for  the  benefit  of  the  waters.  A  relief  fund  being  set  on  foot 
to  aid  infirm  soldiers  on  their  discharge  from  the  hospital.  Miss  Night- 
ingale forwarded  a  donation  of  one  hundred  francs,  through  Lady  Fox 
Strangvt'ays,  widow  of  the  general  who  fell  at  Inkerman.  Accompa- 
n}-ing  this  donation  was  a  graceful  letter,  addressed  to  the  Abb6.  in 
which  she  said,  "  I  feel  the  warmest  sympathy  with  you  in  the  touch- 
ing object  of  your  work,  and  I  ahi  happy  to  join  in  it  to  the  limited 
extent  which  my  own  engagements  allow.  I  received,  too,  from  the  ex- 
cellent religious  ladies  who  were  attached  to  the  French  army  in  the 
East,  so  many  tokens  of  their  friendship,  —  they  gave  me  their  assist- 
ance with  such  entire  self-denial,  and  lightened  my  hard  task  in  the 
hospital  with  so  much  devotedness,  that  I  shall  always  seek  any  op- 
portunity of  showing  my  gratitude  to  France  and  to  her  brave  chil- 
dren, whom  I  have  been  taught  by  these  ladies  to  love  and  respect." 

A  graceful  and  interesting  incident,  in  connection  y\-iih  the  Nightin- 
gale Fund,  occurred  very  recently.  It  will  scarcely  be  forgotten 
that  Mr.  and  ISIadame  Goldschmidt  contributed  more  than  two  thou- 
sand pounds  to  the  fimd,  being  the  proceeds  of  a  grand  concert  given 
at  Exeter  Hall  for  the  piirpose,  when  the  generous  donors  not  only 
performed  gratuitously  themselves,  but  insisted  on  defraying  every  ex- 
pense connected  Avith  the  concert.  This  munificence,  showing  that 
true  genius  is  at  all  times  kindred  and  sympathetic,  excited  such  ad- 
miration, that  several  of  those  who  took  a  deep  interest  in  the  success 
of  the  Nightingale  xindertaking  resolved  to  present  Mr.  and  Madam-e 
Goldschmidt,  as  a  testimony  of  their  regard,  a  copy  in  marble  of  Dur- 
ham's bust  of  Her  Majesty.  This  desire  was  carried  into  effect  at  the 
Mansion  House  on  the  17th  of  last  June,  when  the  Lord  Mayor,  Lord 
Monteagle,  Mr.  and  Madame  Bunsen,  Mr.  and  Mrs.  George  Grote,  Mr. 
and  ^Irs.  S.  C.  Hall,  Dr.  Mackay,  Mrs.  and  Miss  Stanley,  Mr.  Brace- 
bridge,  and  several  other  friends  and  subscribers,  were  pres  nt.  The 
Lord  Mayor  offered  the  bust  in  the  name  of  the  subscribers,  and  truly- 
remarked,  in  a  very  happy  speech,  that  "  gifted  as  Madame  Gold- 
schmidt u  as  with  the  divinest  faculty  of  song,  it  has  been  and  is  her 
greatest  lionor  that  she  has  ever  been  prepared  to  devote  a  proportion 
of  the  proceeds  of  her  genius  to  the  large  purposes  of  charity." 

One  of  the  brightest,  noblest  names  in  the  list  of  brave,  heroic 
women,  is  — 

FLORENCE  NIGHTINGALE, 
xii 


FLORENCE  NIGHTINGALE. 


Florexce  Nightingale  will  be,  tlii-ough  all  time  to  come,  the 
representative  nurse  par  excellence.  In  her  case  it  is  a  special  calling, 
in  virtue  of  natural  capacity,  moral  and  intellectual  at  once.  She  did 
not  set  out  from  any  chosen  starting  point.  She  did  not  propose  to 
earn  her  own  salvation  by  a  life  of  good  works.  She  was  not  incited 
by  visions  of  a  religious  life  in  a  favored  monastic  community.  She 
did  not  aspire  to  take  m  hand  a  department  of  human  misery,  in  order 
to  extinguish  it,  and  then  look  about  to  see  what  particular  misery  it 
should  be.  She  does  not  appear  to  have  had  any  plans  relating  to 
herself  at  all.  Nor  was  she  overtaken  by  the  plague  in  a  village  ;  nor 
did  she  overtake  a  fever  in  a  village  in  the  course  of  her  travels,  like 
her  representative  sisters  of  an  earlier  time  ;  nor  did  she  do  the  work 
of  the  occasion,  and  reenter  ordinary  life  as  if  nothuig  had  happened. 
Her  case  is  special  and  singular  in  every  way. 

Her  childhood  and  youth  Avere  very  much  like  those  of  little  girls 
who  have  wealthy  parents,  and  carefully- chosen  governesses,  and  good 
masters,  and  much  travel  —  in  short,  all  facilities  for  intellectual  culti- 
vation by  study  and  extended  intercourse  with  society,  at  home  and 
abroad. 

The  peculiarity  in  the  case  of  herself  and  her  nearest  relatives  seems 
to  be  their  having  been  reared  in  an  atmosphere  of  sincerity  and  free- 
dom, —  of  reality,  in  fact,  —  which  is  more  difficult  to  obtain  than 
might  be  thought.  There  was  a  certain  force  and  sincerity  of  character 
in  the  elder  members  on  both  sides  of  the  house  which  could  not  but 
affect  the  formation  of  the  children's  characters ;  and  in  this  case  there 
was  a  governess  also  whose  lofty  rectitude  and  immaculate  trutlifuhiess 
commanded  the  reverence  of  all  Avho  knew  her. 

In  childhood  a  domestic  incident  disclosed  to  the  honest-minded 
little  girl  what  her  liking  was,  and  she  followed  the  lead  of  her  natural 
taste.  She  took  care  of  all  cuts  and  bruises,  and  nursed  all  illness 
within  her  reach  ;  and  there  is  always  a  good  deal  of  these  things 
within  the  reach  of  country  gentry  who  are  Avealthy  and  benevolent. 
For  the  usual  term  of  young-lady  life,  Florence  Nightingale  did  as 
other  young  ladies.  She  saw  Italy,  and  looked  at  its  monuments  ; 
she  once  went  to  Egypt  and  Greece  with  the  Bracebridges  ;  she  visited 
in  society,  and  went  to  court.  But  her  heart  was  not  in  the  apparent 
objects  of  her  life  —  not  in  travel  for  amusement,  nor  in  art.  In  liter- 
ature, books  Avhich  disclosed  life  and  its  miseries,  and  character  with 
its  sufferings,  burnt  themselves  in  upon  her  mind,  and  created  much 
of  her  future  effort.  She  Avas  never  resorted  to  for  sentiment.  Senti- 
mentalists ncA'cr  had  a  chance  Avith  her.  Besides  that  her  character 
was  too  strong,  and  its  quality  too  real,  for  any  sympathy  Avith  shal- 
loAvness  and  egotism,  she  had  tAvo  characteristics*  Avhich  might  avcU 
daunt  the  sentimentalists  —  her  reserve,  and  her  capacity  for  ridicule. 
Ill  Avould  they  have  fared  Avho  had  come  to  her  for  responsiA'c  sympa- 
thies about  sentiment,  or  even  real  woes  in  Avhich  no  practical  help 
was  proposed ;  and  there  is  perhaps  nothing  uttered  by  her,  from  her 
evidence  before  the  Sanitary  Commission  for  the  Army  to  her  recently- 
published  "  Notes  on  Nursing,"  Avhich  does  not  disclose  powers  of 
irony  Avhich  self- regardant  persons  may  Avell  dread. 

Such  force  and  earnestness  must  find  or  make  a  career.  She  evi- 
dentlv  believes,  as  all  persons  of  genius  do,  that  she  found  it,  while 
1  (1) 


2  FLOREXCE  NIGiniNGALE, 

others  say  she  made  it.  Philosophy  will  hereafter  reconcile  the  Uvo 
in  her  case  and  many  others.  As  a  matter  of  fact,  whil  ^  otlier  young 
ladies  were  busy,  and  perhaps  better  cmployecl  than  usual,  in.  enjoyiiv^ 
the  great  exhibition,  she  was  in  the  Kaiserwerth  Institution,  on  tb.e 
Rhine,  going  throiigh  the  training  for  nursing,  and  investigating  the 
methods  of  organization  there  and  elsewhere. 

The  strongest  sensation  she  perhaps  evei-  excited  among  her  personal 
acquaintance  was  when  she  ttndertook  to  set  up  the  Sanitarium  in 
Harley  Street,  and  left  home  to  superintend  the  establishment.  Her 
first  M'ork  there  was  chiefly  financial ;  and  the  powers  of  administra- 
tion she  manifested  were  a  complete  justification  of  what  she  had  done 
in  leaving  her  father's  house  to  become  what  people  called  the  matron 
of  a  charity.  At  first  common-minded  people  held  up  hands  and  eyes 
as  if  she  had  done  something  almost  scandalous.  EetAveen  that  day 
and  this  they  must  have  discovered  that  she  could  exalt  any  function, 
and  that  no  function  could  lower  her.  She  rectified  the  accounts,  paid 
the  debts,  and  brought  all  round ;  and  she  always  had  leisure  to  help 
and  comfort  the  sick  ladies  in  the  house.  At  one  time,  I  remember, 
there  was  not  a  case  in  the  house  which  was  not  hopeless  ;  but  there 
was  no  sign  of  dismay  in  Florence  Nightingale.  She  completed  her 
task,  showing  unconsciously  by  it  how  a  woman  as  well  as  a  man  may 
be  born  to  administration  and  command. 

By  a  sort  of  treachery  only  too  common  in  the  visitors  of  celebrated 
people,  Ave  have  all  seen  the  letter  of  ilr.  Sidney  Herbert,  in  1854, 
entreating  Miss  Nightingale  to  go  —  accompanied  by  her  friends  the 
Bracebridges,  who  are  familiar  Avith  life  in  the  East  —  to  Turkey,  to 
minister  among  the  sick  and  Avounded  of  our  array.  How  soon  she 
was  ready,  and  how  she  and  her  band  of  nurses  went,  and  Avere  just 
in  time  to  receive  the  Avounded  from  Inkermann,  no  Englishman  for- 
gets. No  man  of  any  nation  concerned  Avill  ever  forget  her  subsequent 
serA'ices.  She  had  against  her  not  only  a  chaos  of  disorder  in  Avhich 
to  moA-e,  and  a  hell  of  misery  around  her  to  relieve,  but  special  diffi- 
culties in  the  jealousy  of  the  medical  officers,  the  raAvness  of  the  nurses 
so  hastily  collected,  and  the  incompatibilities  of  the  volunteer  ladies 
who  started  on  the  enterprise  Avith  her  or  after  her.  On  the  state  of 
the  hospitals  it  can,  I  hope,  never  be  necessary  to  enlarge  again.  We 
all  knoAv  hoAv,  under  her  superintendence,  places  became  clean  and 
airy,  and  persons  cleanly,  clothed,  fed,  and  aff'orded  some  chance  of 
recovery  from  maladies  or  Avounds.  "While  history  abides,  the  image 
of  Florence  Nightingale,  lamp  in  hand,  going  through  miles  of  beds, 
night  by  night,  noting  every  patient  as  she  Avent,  and  ministering 
Avherever  most  Avanted,  will  always  glow  in  men's  hearts  ;  and  the 
sayings  of  the  men  about  her  Avill  be  traditions  for  future  generations 
to  enjoy. 

She  Avas  prostrated  by  the  Crimean  f?ver  at  Ealaklava,  and  carried 
up  to  the  hospital  on  the  cliff's  till  she  began  to  mend.  Avhen  she  Avas 
taken  to  sea.  She  Avould  not  come  home,  because  her  Avork  at  Scutari 
Avas  not  finished.  She  remained  there  till  the  end  of  the  Avar  ;  by 
Avhieh  time  she  and  her  military  and  medical  coadjutors  had  shoAvn 
Avhat  hospitals  may  be,  and  how  low  the  rate  of  mortality  of  an  army 
may  be  reduced,  even  in  tiuie  of  Avar. 

She  has  ncA'er  recoA'ered  from  that  feA'er  ;  find  for  '^ome  years  she  has 
been,  confined  by  seA^ere  and  increasing  illness.  Not  the  less  has  she 
worked,  steadily  and  most  efficiently.  She  caimot  fulfil  her  aim  — 
of  trainiiig  nurses  in  an  institution  of  her  OAvn,  and  thus  raising  up  a 
body  of  successors.     The  grateful   people  of  England  supplied   the 


FLORENCE  NIGHTLVGALE.  3 

means,  "without  her  knoAvledge  or  desire,  which  was  the  same  thing  as 
imposing  a  ncAv  service  upon  lier.  She  wished  to  decline  it  when  she 
found  how  little  likely  her  health  was  to  improve.  Her  letter  to  the 
trustees  of  the  fund  mUst  be  fresh  in  all  memories,  and  the  reply  of 
the  trustees,  who  satisfied  her  that  the  money  was  accumulating,  and 
the  plan  and  Ihe  public  able  and  willing  to  wait.  If  she  could  not  do 
this  particular  work,  she  has  done  many  others.  Her  written  evidence 
before  the  Sanitary  Commission  for  the  Army  is  a  great  work  in  itself. 
So  are  various  reforms  urged  on  the  military  authorities  by  her  and 
her  coadjutors,  and  now  adopted  by  the  war  office.  Reforms  in  the 
Indian  army  are  about  to  follow.  The  lives  thus  saved  no  one  M'ill 
attempt  to  number  ;  and  the  amount  of  misery  and  vice  precluded  by 
her  scientific  humanity  is  past  all  estimate. 

Her  ••  Notes  on  Nursing,"  prepared  and  issued  in  illness  and  pain, 
are  the  crowning  evidence  of  what  she  is,  and  can  do.  Hitherto  we 
have,  I  trust,  appreciated  and  honored  her  acts  ;  now  we  are  enabled 
to  perceive  and  appreciate  her  mind.  It  was  as  certain  before  as  it 
can  ever  be  that  she  must  have  acquired  no  little  science,  in  various 
departments,  to  produce  the  effects  she  wrought ;  but  we  see  it  all  now. 
We  see  also,  much  more  clearly  than  ever,  her  nioral  characteristics. 
I  will  not  describe  them  when  they  can  be  so  much  better  seen  in  her 
"  Notes  on  Nursing."  Any  one  who  reads  those  Notes  without  being 
moved  in  the  depths  of  his  heart  M'ill  not  understand  the  writer  of  them 
by  any  amount  of  description  ;  and  those  who  have  been  so  moved  do 
not  need  and  will  not  tolerate  it.  The  intense  and  exquisite  humanity* 
to  the  sick,  underlying  the  glorious  common  sense  about  affairs,  and  . 
the  stern  insight  into  the  weaknesses  and  the  perversions  of  the 
healthy,  troubled  as  they  are  by  the  sight  of  suffering,  and  sympa- 
thizing with  themselves  instead  of  the  patient,  lay  open  a  good  deal 
of  the  secret  of  this  wonderful  woman's  life  and  power.  We  begin  to 
see  how  a  woman,  any  thing  but  robust  at  any  time,  may  have  been 
able,  as  well  as  willing,  to  undertake  whatever  was  most  repulsive  and 
most  agonizing  in  the  care  of  wounded  soldiers  and  crowds  of  cholera 
patients.  We  see  how  her  minute  economy  and  attention  to  the  small- 
est details  are  reconcilable  with  the  magnitude  of  her  administration, 
and  the  comprehensiveness  of  her  plans  for  hospital  establishments, 
and  for  the  reduction  of  the  national  rate  of  mortality.  As  the  livos 
of  the  sick  hang  on  small  things,  she  is  as  earnest  about  the  quality 
of  a  cup  of  arrowroot,  and  the  opening  and  shutting  of  doors,  as  about 
the  institution  of  a  service  between  the  commissariat  and  the  regi- 
mental, which  shall  insure  an  army  against  being  starved  when  within 
reach  of  food.  In  the  mind  of  a  true  nurse  nothing  is  too  great  or 
too  small  to  be  attended  to  Avith  all  diligence  ;  and  therefore  we  have 
seen  Florence  Nightingale  doing  and  insisting  upon  the  right  about 
shirts  and  toAvels,  spoon-mcate,  and  the  boiling  of  rice,  and  largely 
aiding  in  reducing  the  mortality  of  the  army  from  nineteen  in  the 
thousand  to  eight,  in  times  of  peace. 

In  the  spirit  and  tone  of  this  book  we  see,  too,  how  it  is  that,  with 
all  her  fame,  we  have  known  so  little  of  the  woman  herself.  Where 
it  is  of  use  to  tell  any  piece  of  her  own  experience,  she  tills  it ;  and 
these  scraps  of  autobiography  will  be  eagerly  sei;^cd  upon  by  all  kinds 
of  readers  ;  but,  except  for  the  purpose  of  direct  utility,  she  never 
speaks  of  herself,  more  or  less,  or  even  discloses  any  of  her  opinions, 
views,  or  feelings.  This  reserve  is  a  great  distinction  in  these  days  of 
self-exposure,  and  descanting  on  personal  experiences.  It  is  th(;  l)est 
possible  rebuke  to  the  egotism,  or  the  sentimentality,  which  has  led 


4  FLORENCE  NIGHTINGALE. 

several  ladies  to  imagine  thnt  they  could  be  nurses,  without  having 
tried  whether  they  could  bear  the  discipline.  Her  pure,  undisguised 
common  sense,  and  her  keen  perception  of  all  deviations  from  common 
sense,  may  have  turned  back  more  or  fewer  women  from  the  nursing 
vocation  ;  but  this  is  probably  an  vuimixed  good  ;  for  those  Avho  could 
be  thus  turned  back  were  obviously  unfit  to  proceed.  She  is  the  rep- 
resentative of  those  only  who  are  nurses  ;  that  is,  capable  of  the  hardest 
and  highest  duties  and  sacrifices  which  women  can  undertake  from 
love  to  their  race. 

In  the  end  she  will  have  won  over  far  more  than  she  can  have  (most 
righteously  and  mercifully)  discouraged.  Generations  of  women  for 
centuries  to  come  will  be  the  better,  the  more  helpful,  and  the  more 
devoted  for  Florence  Nightingale  having  lived  ;  and  no  small  number 
of  each  generation  will  try  their  strength  on  that  difficult  path  of 
beneficence  which  she  has  opened,  and  on  which  her  image  will  for- 
ever stand  to  show  the  way.  Ingleby  Scott. 


THE    JEWEL    PRESENTED    TO    MISS    NIGHTINGALE, 
BY    QUEEN    VltTORIA. 


INDEX 


PAGE 

Disease  a  reparative  process,    .  .     7 
Of  the  sufferin<^8  of  disease ;  disease 

not  always  the  cause, 7 

What  mirsiiig  ou^dit  to  do,    ....      8 
Nursiug^  the  siek  little  understood,      8 
Nurpinf,--  ouf,'-ht  to  assist  the  repara- 
tive proccns, 8 

Kursiuf^  the  well  little  understood,      9 
Curious  deductions  from  an  exces- 
sive death  rate, 9 

First  rule  of  nursing  to  keep  the  air 

within  as  pure  as  the  air  without,    11 
Why  are  uninhabited  rooms  shut 

up? 11 

Without  chill, 12 

Open  windows, 13 

What  kind  of  warmth  desirable, .  .    13 
Bedrooms  almost  universally  foul,    13 
An  air-test  of  essential  consequence,    14 
When  warmth  must  be  most  care- 
fully looked  to, 14 

Cold  air  not  ventilation,  nor  fresh 

air  a  method  of  chill, 15 

Kight  air.  Air  from  outside.    Open 

your  windows,  shut  your  doors,      IG 
Smoke.     Airing  damp  things  in  a 
patient's    room.     Effluvia    from 

excreta, 17 

Chamber  utensils  without  lids,    .  .    18 
Don't  make  your  sick  room  into  a 

sewer, 18 

Abolish  slop-pails.  Fumigations. 
Health  of  houses  —  five  points  es- 
sential.    Health  of  carriages,  .   .    19 

Pure  air.    Pure  water, 20 

Drainage.    Sinks, 21 

Cleanliuess.    Light, -22 

Three  common  errors  in  managing 

the  health  of  houses, 22 

Head  in  charge  must  see  to  house 

hygiene,  not  do  it  herself, ....    23 
Does  God  think  of  these  things  so 

seriously  ?      23 

How  does  he  carry  out  his  laws  ?   .    24 
How  does  he  teach  his  laws .''...    24 

Servants'  rooms, 24 

Physical  degeneration  in  families ; 
its  causes.  Don't  make  your  sick 
room  into  a  ventilating  shaft  for 
the  whole  house.  lufuction.  Dis- 
eases are  not  individuals  arranged 
in  classes,  like  cats  and  dogs,  but 
conditions  growing  out  of   one 

another, 25 

Why  must  children  have  measles, 

&c.  ?  Petty  management,  ....  27 
Hlustrations  of  the  want  of  it,  .  .  .  28 
Strangers  coming  into  sick  room,  .  28 
Sick  room  airing  the  whole  house,  ,  28 
Uninhabited  room  fouling  the 
whole  house.   Lingering  smell  of 

p;iiut  a  want  of  care, 28 

Delivery  and  non-delivery  of  letters 

and  messages, 29 

Partial  measures  such  as  "  being  al- 

1* 


Pl.  .'V 

ways  in  the  way  "  yourself,  in- 
crease instead  of  savin"-  the  pa- 
tient's anxiety,  because  tney  must 
be  only  partial.  Why  let  your 
patient  ever  be  surprised.' .  ...  29 
AVhat  is  the  cause  of  half  the  aeci- 

dents  which  happen  ? 30 

Petty  management  better  under- 
stood in  institutions  than  in  pri- 
vate houses.  What  institutions 
are  the  exception  ?    Nursing  in 

regimental  hospitals, 31 

What  it  is  to  be  "  in  charge,"  ...    32 
Why  hired  nurses  give  so  much 
trouble.  Unnecessary  noise.  Nev- 
er let  a  patient  be  waked  out  of 

his  first  sleep, 34 

Noise  which  excites  expectation,  .  35 
Whispered    conversation    in     the 

room,  or  just  outside  the  door,  35, 36 
Noise  of  female  dress.      Patient's 
repulsion  to  nurses  who  rustle,  .    36 

Burning  of  the  crinolines, 37 

Indecency  of  the  crinolines,  ....  37 
Hurry  peculiarly  hurtful  to  sick,  .  37 
How  to  visit  the  sick,  and  not  hurt 

them.     These  things  not  fancy,  .    38 
Interruption  damaging  to  sick  and 

to  well, 38, 39 

Keeping  a  patient  standing.     Pa- 
tients dread  surprise.  Never  speak 
to  a  patient  in  the  act  of  moving,    39 
Effects  of  over-exertion  on  sick, .  .   40 
Careless  observation  of  the  results 

of  careless  visits, 40 

Difference  between  real  and  fancy 

patients, 41 

Conciseness  necessary*vith  sick,  .  41 
Irresolution  most  painful  to  them,  43 
What  a  patient  must  not  have  to    42 

see  to.     Reading  aloud, 42 

Read  aloud  slowly,  distinctly,  and 

steadily  to  the  sick, 43 

Never  read  aloud  by  fits  and  starts 
to  the  sick.  The  sick  would  rather 
be  told  a  thing  than  have  it  read 

to  them, 43 

People  overhead.    Music, 44 

Variety  a  means  of  recovery,   ...    44 
Color  and  form  means  of  recovery  ; 
this  is  no  fancy.    Flowers,    ...    45 

Effect  of  body  on  mind, 40 

Sick  suffer  to  excess  from  mental  as 
well    as  bodily  pahi.    Help  the 
sick  to  vary  their  thoughts,  ...    40 
Desperate  desire  in  the  sick  to  "  see 
out  of  window."    Supply  to  the 
sick  the  defect  of  manual  lalwr,   .    47 
Physical  effect  of  color.  Want  of  at- 
tention to  hours  of  taking  food,  .    4fti 
Life  often  hangs  upon  minutes  in 

taking  food, 49 

Patients  often  starved  to  death  in 
chronic  cases.     Food  never  to  bo 
left  by  the  patient's  side.     Pa- 
(5) 


INDEX. 


PAGE 

ticnt  had  better  not  see  more 
loud  tliaii  his  own, 50 

You  cauuot  be  too  careful  as  to 
quality  in  sick  diet, 51 

Nurse  must  have  some  rule  of 
thought  about  her  patient's  diet. 
Nurse  must  have  some  ride  of 
time  about  the  patient's  (Uet,    .   .    52 

Keep  your  patient's  cup  dry  under- 
neath. Common  errors  in  diet. 
Beef  tea.  Eggs.  3Ieat  without 
vegetables, 53 

Arrowroot.  Milk,  butter,  cream,  &g. 
Intelligt-nt  cravings  of  particular 
sick  for  particular  articles  of  diet,    54 

Sweet  things.    Jelly, 55 

Beef  tea.  Observation,  not  chemis- 
try, must  decide  sick  diet,  .  .  .  .    5G 

Home-made  bread.  Sound  obser- 
vation has  scarcely  yet  been 
brought  to  bear  on  sick  diet,  ...    57 

Tea  and  coffee.    Cocoa, 58, 59 

Bulk.  Feverishness  a  symptom  of 
bedding.  Uncleanliness  of  ordi- 
nary bedding.  Nurses  often  do 
not  think  the  sick  room  any  busi- 
ness of  theirs,  but  only  the  sick,     60 

Air  your  dirty  sheets,  not  only  your 
clean  ones, •    .   .    61 

Iron  siJring  bedsteads  the  best. 
Comtort  and  cleanliness  of  two 
beds.    Bed  not  to  be  too  wide,  .   .    62 

Bed  not  to  be  too  high,  nor  in  a 
dark  place,  nor  a  four-poster  with 
curtains.  Scrofula  often  a  result 
of  disposition  of  bed  clothes. 
Bed  sores.  Heavy  and  impervi- 
ous bed  clothes, 63 

Light  essential  to  both  health  and 
recovery, 64 

Aspect,  view,  ami  sunlight,  matters 
of  lirst  importance  to  the  sick, .  .    65 

Without  sunlight,  we  degenerate 
body  and  mind.  Almost  all  pa- 
tients lie  with  their  faces  to  tlie 
light.  Cleanliness  of  carpets  and 
furniture, 66 

Dust  never  removed  now.  How  a 
room  is  dunted, 67 

Floors.  Papered,  plastered,  oil- 
painted  walls.  Atmosphere  in 
painted  and  papered  rooms  quite 
distinguishable.  Best  kind  of 
wall  for  a  sick  room.  How  to 
keep  your  wall  clean  at  the  ex- 
pense of  your  clothes, 68 

Dirty  air  from  without.  Best  kind 
of  wall  for  a  house.  Dirty  air 
from  within.  Dirty  air  Irom  the 
carpet.    Kemedies, 69 

Poisoning  by  the  skin, 70 

Ventilation  and  skin-cleanlinesa 
equally  essential, 71 

Steaming  and  rubbing  the  skin. 
Advising  the  sick, 72 

Chattering  hopes  the  bane  of  the 
sick, 73 

Patient  does  not  want  to  talk  of 
himself.  Absurd  statistical  com- 
parisons made  in  common,  coa- 


PAO> 

versation  by  the  most  sensible 
people  for  tlie  benefit  of  the  sick. 
Absurd  consolations  put  forth  for 
the  benefit  of  the  sick, 74 

Wonderful  presumption  of  the  ad- 
visers of  tlie  sick.  Advisers  the 
same  now  as  two  hundred  years 
ago.  Mockery  of  the  advice  given 
to  sick, 76 

Means  of  giving  pleasure  to  the 
sick, 77 

Two  new  classes  of  patients  pe- 
culiar to  this  generation.  What 
is  tlie  use  of  the  question,  Is  he 
better .' 79 

Leading  questions  useless  or  mis- 
leading,   81 

Means  of  obtaining  inaccurate  in- 
formation,   82 

As  to  food  patient  takes  or  does 
not  take, 83 

As  to  diari-hoea.  More  important  to 
spare  the  patient  thouglit  than 
physical  exertion.  Means  of  cul- 
tivating sound  and  ready  obser- 
vation,   83,84 

Sound  and  ready  observation  essen- 
tial in  a  nurse, 85 

English  women  have  great  capacity 
of,  but  little  practice  in,  close  ob- 
servation,   86 

Difference  of  excitable  and  accumu- 
lative  temperaments.  Supersti- 
tion the  fVuit  of  bad  observation. 
Physiognomy  of  disease  little 
shown  by  the  face, 87 

Peculiarities  of  patients.  Nurse 
must  observe  for  herself  increase 
of  patient's  weakness ;  patient 
will  not  tell  her.  Accidents  aris- 
ing from  the  nurse's  want  of  ob- 
servation,         89 

Is  tlie  faculty  of  observing  on  the 
decline  i  Observation  of  general 
conditions.  Approach  of  death  ; 
paleness  by  no  means  an  invaria- 
ble effect,  as  we  find  in  novels,.   .    90 

"  Average  rate  of  mortality  "  tells 
us  only  that  so  many  per  cent, 
will  die.  Observation  must  tell 
us  ivhich  in  the  hundred  they  will 
be  who  will  die, 93 

What  observation  is  for.  What  a 
confidential  nurse  should  be,  .   .    94 

Observation  is  for  practical  pur- 
poses. Sanitary  nursing  as  es- 
sential in  surgical  as  in  medical 
cases,  but  not  to  supersede  surgi- 
cal nursing, 95 

Children  :  their  greater  susceptibil- 
ity to  the  same  things, 90 

Summary.  Keckless  amateur  phys- 
icking by  women.  Keal  knowl- 
edge of  the  laws  of  health  alone 
can  check  this.  Danger  of  j^hys- 
icldng  by  amateur  females,    ...    98 

What  pathology  teaches.  What  ob- 
servation alone  teaches.  What 
medicine  does.  What  nature  alone 
does, lOQ 


^WES  ON  NURSING 


WHAT  IT  IS  AND  ^VHAT  IT  IS  NOT. 


3>«=;c 


Shall  we  begin  by  taking  it  as  a  general  principle  — • 
that  all  disease,  at  some  period  or  other  of  its  course,  is 
more  or  less  a  reparative  process,  not  necessarily  accom- 
panied with  suifering:  an  effort  of  nature  to  remedy  a 
process  of  poisoning  or  of  decay,  which  has  taken  place 
weeks,  months,  sometimes  years  beforehand,  unnoticed, 
the  termination  of  the  disease  bfeing  then,  while  the  an- 
tecedent process  was  going  on,  determined  ? 

If  we  accept  this  as  a  general  principle,  we  shall  be  im- 
mediately met  with  anecdotes  and  instances  to  prove  the 
contrary.  Just  so  if  we  were  to  take,  as  a  principle  —  all 
the  climates  of  the  earth  are  meant  to  be  made  habitable 
for  man,  by  the  efforts  of  man  —  the  objection  Avould  be 
immediately  raised,  —  Will  the  top  of  Blount  Blanc  ever 
be  made  habitable  ?  Our  answer  would  be.  It  will  be 
many  thousands  of  years  before  we  have  reached  the  bot- 
tom of  Mount  Blanc  in  making  the  earth  healthy.  Wait 
till  we  have  reached  the  bottom  before  we  discuss  the  top. 

In  watching  diseases,  both  in  private  houses  and  in 
public  hospitals,  the  thing  which  strikes  the  experienced 
observer  most  forcibly  is  this,  that  the  symptoms  or  the 
sufferings  generally  considered  to  be  inevitable  and  inci- 
dent to  the  disease  are  very  often  not  symptoms  of  the 
disease  at  all,  but  of  sometliing  quite  different  —  of  the 
want  of  fresh  air,  or  of  hglit,  or  of  warmth,  or  of  quiet,  or 
of  cleanliness,  or  of  punctuality  and  care  in  the  adminis- 
tration of  diet,  of  each  or  of  all  of  these.  And  this  quite 
as  much  in  private  as  in  hospital  nursing. 

The  reparative  process  Avhich  Xature  has  instituted  and 

K7) 


8  NOTES   ON  NURSING. 

which  we  call  disease,  has  been  hindered  by  some  want  of 
knowledge  or  attention,  in  one  or  in  all  of  these  things, 
and  pain,  suffering,  or  interruption  of  the  whole  process 
sets  in. 

If  a  patient  is  cold,  if  a  patient  is  feverish,  if  a  patient 
is  faint,  if  he  is  sick  after  taking  food,  if  he  has  a  bed-sore, 
it  is  generally  the  fault  not  of  the  disease,  but  of  the 
nursing. 

I  use  the  word  nursing  for  want  of  a  better.  It  has 
been  limited  to  signify  httle  more  than  the  administration 
of  medicines  and  the  application  of  poultices.  It  ought  to 
signify  the  proper  use  of  fresh  aii-,  light,  warmth,  cleanli- 
ness, quiet,  and  the  proper  selection  and  administration 
of  diet  —  all  at  the  least  expense  of  vital  power  to  the 
patient. 

It  has  been  said  and  wi-itten  scores  of  times,  that  every 
woman  makes  a  good  nurse.  I  believe,  on  the  contrary, 
that  the  very  elements  of  nursing  are  all  but  unknown. 

By  this  I  do  not  mean  that  the  nurse  is  always  to  blame. 
Bad  sanitary,  bad  architectural,  and  bad  administrative 
aiTangements  often  make  it  impossible  to  nurse.  But  the 
art  of  nursing  ought  to  include  such  an-angements  as  alone 
make  what  I  understand  by  nursing,  possible. 

The  art  of  nursing,  as  now  practised,  seems  to  be  ex- 
pressly constituted  to  unmake  what  God  had  made  disease 
to  be,  viz.,  a  reparative  process. 

To  recur  to  the  first  objection.  If  we  are  asked,  Is  such 
or  such  a  disease  a  reparative  process  ?  Can  such  an  ill- 
ness be  unaccompanied  with  suffering?  Will  any  care 
prevent  such  a  patient  from  suffering  this  or  that?  —  I 
humbly  say,  I  do  not  know.  But  when  you  have  done 
away  with  all  that  pain  and  suffering,  which  in  patients 
are  the  symptoms,  not  of  their  disease,  but  of  the  absence 
of  one  or  all  of  the  above-mentioned  essentials  to  the  suc- 
cess of  ISTature's  reparative  processes,  we  shall  then  know 
what  are  the  symptoms  of  and  the  sufferings  inseparable 
from  the  disease. 

Another  and  the  commonest  exclamation  which  will 
be  instantly  made  is  —  Would  you  do  nothing,  then,  in 
cholera,  fever,  &c.  ?  —  so  deep-rooted  and  universal  is  the 
conviction  that  to  give  medicine  is  to  be  doing  something, 
or  rather  every  thing ;  to  give  air,  warmth,  cleanliness,  &c., 
is  to  do  nothing.     The  reply  is,  that  in  these  and  many 


NOTES  ON   NURSING.  '9 

other  similar  diseases  the  exact  vaUie  of  pai-ticular  reme- 
dies and  modes  of  treatment  is  by  no  means  ascertained, 
while  there  is  universal  experience  as  to  the  extreme  im- 
portance of  careful  nursing  in  determining  the  issue  of  the 
disease. 

11.  The  very  elements  of  what  constitutes  good  nursing 
are  as  httle  understood  for  the  well  as  for  the  sick.  The 
same  laws  of  health  or  of  nursing,  for  they  are  in  reality 
the  same,  obtain  among  the  well  as  among  the  sick.  The 
bi'eaking  of  them  produces  only  a  less  violent  consequence 
among  the  former  than  among  the  latter,  —  and  this  some- 
times, not  always. 

It  is  constantly  objected,  —  "  But  how  can  I  obtain  this 
medical  knowledge  ?  I  am  not  a  doctor.  I  must  leave 
this  to  doctor." 

O,  mothers  of  families  !  You  who  say  this,  do  you 
know  that  one  in  every  seven  infants  in  this  civilized  land 
of  England  perishes  before  it  is  one  year  old  ?  That,  in 
London,  two  in  every  five  die  before  they  are  five  years 
old  ?  And,  in  the  other  great  cities  of  England,  nearly 
one  out  of  two  ?  *     "  The  Ufe  duration  of  tender  babies  " 

*  Upon,  this  fact  the  most  wonderful  deductions  have  been  strung. 
For  a  long  time  an  announcement  something  like  the  following  has 
been  going  the  round  of  the  papers:  "More  than  25,000  children 
die  every  year  in  London  under  10  years  of  age  ;  therefore  we  want  a 
Children's  Hospital."  This  spring  there  was  a  prospectus  issued,  and 
divers  other  means  taken  to  this  effect:  "There  is  a  great  want  of 
sanitary  knoM'ledge  in  women  ;  therefore  we  want  a  Woman's  Hospi- 
tal." Now,  both  the  above  facts  are  too  sadly  true.  But  what  is 
the  deduction  r  The  causes  of  the  enormous  child-mortality  are  per- 
fectly well  known ;  they  are  chiefly  want  of  cleanliness,  want  of  ven- 
tilation, want  of  whitewashing ;  m  one  word,  defective  household  hy- 
giene. The  remedies  are  just  as  well  known ;  and  among  them  is 
certainly  not  the  establishment  of  a  Child's  Hospital.  This  may  be  a 
want ;  just  as  there  may  be  a  want  of  hospital  room  foi  adults.  But 
the  Registrar- General  would  certainly  never  think  of  giving  us  as  a 
cause  for  the  high  rate  of  child-mortality  in  (say)  Liverpool  that  there 
was  not  sufficient  hospital  room  for  children  ;  nor  would  he  urge  upon 
us,  as  a  remedy,  to  found  a  hospital  for  them. 

Again,  women,  and  the  best  women,  are  wofully  deficient  m  sanitary 
knowledge  ;  although  it  is  to  women  that  we  must  look,  first  and  last, 
for  its  application,  as  far  as  household  hygiene  is  concerned.  But  who 
would  ever  thmk  of  citing  the  institution  of  a  Woman's  Hospital  aa 
the  way  to  cure  this  want  ? 

We  have  it,  indeed,  upon  very  high  authority  that  there  is  some  ft^ar 
lest  hospitals,  as  they  have  been  hitherto,  may  not  have  generally 
increased,  rather  than  diminished,  the  rate  of  mortality  —  especially  of 
child-mortalitv. 


10  NOTES   ON   NURSING. 

(as  some  Saturn,  turned  analytical  chemist,  says)  "is  the 
most  delicate  test  ^  of  sanitary  conditions.  Is  all  this  pre- 
mature suffering  and  death  necessary  ?  Or  did  Nature 
intend  mothers  to  be  always  accompanied  by  doctors? 
Dr  is  it  better  to  learn  the  piano-forte  than  to  learn  the 
laws  which  subserve  the  preservation  of  offspring  ? 

Macaulay  somewhere  says,  that  it  is  extraordinaiy  that, 
whereas  the  laws  of  the  motions  of  the  heavenly  liodies, 
far  removed  as  they  are  from  us,  are  perfectly  well  under- 
stood, the  laws  of  the  human  mind,  which  are  under  our 
observation  all  day  and  every  day,  are  no  better  under- 
stood than  they  were  two  thousand  years  ago. 

But  how  much  more  extraordinary  is  it  that,  whereas 
what  we  might  call  the  coxcombries  of  education  —  e.  g^ 
the  elements  of  astronomy  —  are  now  taught  to  every 
school-girl,  neither  mothers  of  fkmihes  of  any  class,  nor 
school-mistresses  of  any  class,  nor  nurses  of  children,  nor 
nurses  of  hospitals,  are  taught  any  thing  about  those  laws 
which  God  has  assigned  to  the  relations  of  our  bodies  with 
the  world  in  which  He  has  put  them.  In  other  words,  the 
laws  wliich  make  these  bodies,  into  which  He  has  put  our 
minds,  healthy  or  unhealthy  organs  of  those  minds,  are  all 
but  unlearnt.  Xot  but  that  these  laws  —  the  laws  of  life 
—  are  in  a  certain  measure  understood,  but  not  even 
mothei-s  think  it  worth  their  while  to  study  them  —  to 
study  how  to  give  their  children  healthy  existences.  They 
call  it  medical  or  physiological  knowledge,  fit  only  for 
doctors. 

Another  objection. 

We  are  constantly  told,  — "  But  the  circumstances 
which  govern  our  children's  healths  are  beyond  our  con- 
trol. What  can  we  do  with  winds  ?  There  is  the  east 
wind.  Most  people  can  tell  before  they  get  up  in  the 
morning  whether  the  wind  is  in  the  east." 

To  this,  one  can  answer  with  more  certainty  than  to  the 
former  objections.  Who  is  it  who  knows  when  the  wind 
is  in  the  east?  Not  the  Highland  drover,  certainly,  ex- 
posed to  the  east  wind,  but  the  young  lady  who  is  worn 
out  with  the  want  of  exposure  to  the  fresh  air,  to  sunlight, 
&c.  Put  the  latter  under  as  good  sanitary  circumstances 
as  the  former,  and  she  too  will  not  know  when  the  wind 
is  in  the  east. 


VENTILATION   AND  "FARMING.  11 


I.     VEXTILATIOX  AND   WARMING. 

The  very  first  canon  of  nursing,  the  first  and  the  last 
thing  upon  which  a  nurse's  attention  must  be  fixed,  the 
first  essential  to  a  patient,  without  which  all  the  rest  you 
can  do  fisr  him  is  ao  nothing,  with  which  I  had  almost 
said  you  may  leave  all  the  rest  alone,  is  this :   To  keep 

THE  AIR  HE  BREATHES  AS  PURE  AS  THE  EXTEEXAL  AIR, 

WITHOUT  CHiLLixG  HIM.  Yct  wliat  is  SO  little  attended 
to  ?  Even  where  it  is  thought  of  at  all.  the  most  exti-aor- 
dinary  misconceptions  reign  about  it.  ±L'\'en  in  admitting 
air  into  the  patient's  room  or  ward,  few  people  ever  think, 
where  that  air  comes  from.  It  may  come  from  a  corridor 
into  which  other  wards  are  ventilated,  from  a  hall,  always 
unaired,  always  full  of  the  fumes  of  gas,  dinner,  of  various 
kinds  of  mustiness  ;  from,  an  underground  kitchen,  sink, 
washhouse,  water-closet,  or  even,  as  I  myself  have  had 
sorrowful  experience,  from  open  sewei-s  loaded  with  filth; 
and  with  this  the  patient's  room  or  ward  is  aired,  as  it  is 
called  —  poisoned,  it  should  rather  be  said.  Always  air 
from  the  air  without,  and  that,  too,  through  those  windows 
through  which  the  air  comes  freshest.  From  a  closed 
court,  especially  if  the  wind  do  not  blow  that  way,  air  may 
come  as  stagnant  as  any  from  a  hall  or  corridor. 

Again,  a  thing  I  have  often  seen  both  in  private  houses 
and  institutions.  A  room  remains  uninhabited;  the  fire- 
place is  carefully  fastened  up  with  a  board ;  the  windows 
are  never  opened ;  probably  the  shutters  are  kept  always 
shut ;  perhaps  some  kind  of  stores  are  kept  in  the  room ; 
no  breath  of  fresh  air  can  by  possibility  enter  into  that 
room,  nor  any  ray  of  sun.  The  air  is  stagnant,  musty,  and 
corrupt  as  it  can  by  possibility  be  made.  It  is  quite  ripe 
to  breed  small-pox,  scarlet-fever,  diphtheria,  or  any  thing- 
else  you  please.* 

Yet  the  nursery,  ward,  or  sick  room  adjoining  will  posi 

*  The  common  idea  as  to  uninhabited  rooms  is,  that  they  may  safely 
be  left  Avith  doors,  -windows,  shutters,  and  chimney-board,  all  closest 
—  hermetically  sealed  if  possible  —  to  keep  out  the  dust,  it  is  said 
and  that  no  harm  will  happen  if  the  room  is  but  opened  a  short  hoiix 
before  the  inmates  are  put  in.  I  have  often  been  asked  the  question 
for  uninhabited  rooms,  «'  But  when  ought  the  windows  to  be  opened  ?  " 
The  answer  is,  "  When  ought  they  to  be  shut  ?  " 


12  NOTES   ON   NURSING. 

tively  be  aired  (?)  by  having  the  door  opened  into  that 
room.  Or  children  will  be  put  into  that  room,  without 
previous  preparation,  to  sleep. 

A  short  time  ago  a  man  walked  into  a  back-kitchen  in 
Queen  square,  and  cut  the  throat  of  a  poor  consumptive 
creature,  sitting  by  the  fire.  The  murderer  did  not  deny 
the  act,  but  simply  said,  "It's  all  right."  Of  course  he 
was  mad. 

But  in  om'  case,  the  extraordinary  thing  is  that  the  vic- 
tim says,  "It's  all  right,"  and  that  we  are  not  mad.  Yet, 
although  we  "  nose  "  the  murderers,  in  the  musty,  unaired, 
unsunned  room,  the  scarlet  fever  which  is  behind  the  door, 
or  the  fever  and  hospital  gangrene  which  are  stalking 
among  the  crowded  beds  of  a  hospital  ward,  we  say,  "It's 
all  right." 

With  a  proper  supply  of  windows,  and  a  proper  supply 
of  fuel  in  open  fire-places,  fi-esh  air  is  comparatively  easy 
to  secure  when  your  patient  or  patients  are  in  bed.  Never 
be  afraid  of  open  windows  then.  People  don't  catch  cold 
in  bed.  This  is  a  popular  fallacy.  With  proper  bed- 
clothes and  hot  bottles,  if  necessary,  you  can  always  keep 
a  patient  warm  in  bed,  and  well  ventilate  him  at  the  same 
time. 

But  a  careless  nurse,  be  her  rank  and  education  what  it 
may,  will  stop  up  every  cranny  and  keep  a  hot-house  heat 
when  her  patient  is  in  bed,  —  and,  if  he  is  able  to  get  up, 
leave  him  comparatively  unprotected.  The  time  when 
people  take  cold  (and  there  are  many  ways  of  taking  cold, 
besides  a  cold  in  the  nose,)  is  when  they  first  get  up  after 
the  two-fold  exhaustion  of  dressing  and  of  having  had  the 
skin  relaxed  by  many  hours,  periiaps  days,  in  bed,  and 
thereby  rendered  more  incapable  of  reaction.  Then  the 
same  temperature  which  refreshes  the  patient  in  bed  may 
destroy  the  patient  just  risen.  And  common  sense  will 
point  out,  that,  while  purity  of  air  is  essential,  a  tempera- 
ture must  be  secured  which  shall  not  chill  the  patient. 
Otherwise  the  best  that  can  be  expected  will  be  a  feverish 
reaction. 

To  have  the  air  within  as  pure  as  the  air  without,  it  is 
not  necessary,  as  often  appears  to  be  thought,  to  make  it 
as  cold. 

In  the  afternoon  again,  without  care,  the  patient  whose 
vitaJ  Dowej's  have  then  risen  often  finds  the  room  as  close 


VENTILATION    AND   WARMING.  13 

and  oppressive  as  he  found  it  cold  in  the  morning.  Yet 
the  niii-se  will  be  terrified,  if  a  window  is  opened.* 

I  know  an  intelligent  humane  house  surgeon  who  makes 
a  practice  of  keeping  the  ward  windows  open.  The  phy- 
sicians and  surgeons  invariably  close  them  while  going 
their  rounds ;  and  the  house  surgeon  very  properly  as  in- 
variably opens  them  whenever  the  doctors  have  turned 
their  backs. 

In  a  little  book  on  nursing,  published  a  short  time  ago, 
we  are  told,  that,  "  with  proper  care  it  is  very  seldom  that 
the  windows  cannot  be  opened  for  a  few  minutes  twice  in 
the  day  to  admit  fresh  air  from  without."  I  should  think 
not ;  nor  twice  in  the  hour  either.  It  only  shows  how  lit- 
tle the  subject  has  been  considered. 

Of  ail  methods  of  keeping  patients  warm  the  very  worst 
certainly  is  to  depend  for  heat  on  the  breath  and  bodies  of 
the  sick.  I  have  known  a  medical  officer  keep  his  ward 
windows  hermetically  closed.  Thus  exposing  the  sick  to 
all  the  dangers  of  an  infected  atmosphere,  because  he  v/as 
afraid  that,  by  admitting  fresh  air,  the  .temperature  of  the 
ward  would  be  too  much  lowered.  This  is  a  destructive 
fallacy. 

To  attempt  to  keep  a  ward  warm  at  the  expense  of 
making  the  sick  repeatedly  breathe  their  own  hot,  humid, 
putrescing  atmosj^here  is  a  certain  way  to  delay  recoveiy 
or  to  destroy  life. 

Do  you  ever  go  into  the  bed-rooms  of  any  persons  of 
any  class,  whether  they  contain  one,  two,  or  twenty  peo- 
ple, whether  they  hold  sick  or  well,  at  night,  or  before  the 
windows  are  opened  in  the  morning,  and  ever  find  the  air 
any  thing  but  unwholesomely  close  and  foul?  And  why 
should  it  he  so?  And  of  hoAV  much  importance  is  it  that 
it  should  not  be  so?  During  sleep, the  human  body,  even 
when  in  health,  is  far  more  injured  by  the  influence  of  foul 
air  than  when  awake.     Why  can't  you  keej)  the  air  all 


*  It  is  very  dosirable  that  the  windows  in  a  sick  room  should  be 
such  that  the  patient  shall,  if  he  can  move  about,  be  able  to  open  and 
shut  them  easily  himself.  In  fact,  the  sick  room  is  very  seldom  kept 
aired  if  this  is  not  the  case  —  so  very  few  people  have  any  perception 
of  what  is  a  healthy  atmosphere  for  the  sick.  The  sick  man  often 
says,  '«  This  room  where  I  spend  22  hours  out  of  the  24,  is  fresher 
than  the  other  where  I  only  spend  2.  Because  here  I  can  manage  tlie 
windows  myself,"  And  it  is  true. 
2 


14  NOTES  ON  NURSING, 

night,  then,  as  pure  as  the  air  without  in  the  rooma  jon 
sleep  in?  But  for  this,  you  must  have  sufficient  outlet  for 
the  impure  air  you  make  yourselves  to  go  out ;  sufficient 
inlet  for  the  pure  air  from  without  to  come  in.  You  must 
have  open  chimneys,  open  windows,  or  ventilators ;  no 
close  curtains  round  your  beds ;  no  shutters  or  curtains  to 
your  windows,  none  of  the  contnvanccs  by  v>'hich  you  un- 
dermine your  own  health  or  destroy  the  chances  of  re- 
covery of  your  sick.* 

A  careful  nurse  will  keep  a  constant  watch  over  her 
sick,  especially  weak,  protracted,  and  collapsed  cases,  to 
guard  against  the  effects  of  the  loss  of  vital  heat  by  the 
patient  himself.  In  certain  diseased  states  much  less  heat 
is  produced  than  in  health ;  and  there  is  a  constant  ten- 
dency to  the  decline  and  ultimate  extinction  of  the  vital 
powers  by  the  call  made  upon  them  to  sustain  the  heat  of 
the  body.  Cases  where  this  occurs  should  be  watched 
with  the  greatest  care  from  hour  to  hour,  I  had  almost  said 

*  Dr.  An^^s  Smith's  air-test,  if  it  could  be  made  of  simpler  appli- 
cation, -would  be  invaluable  to  use  in  every  sleeping  and  sick  room. 
Just  as  without  the  use  of  a  thermometer  no  nurse  should  ever  put  a 
patient  into  a  bath,  so  should  no  nurse,  or  mother,  or  superintendent, 
be  -without  the  air-test  in  any  ward,  nursery,  or  sleeping-room.  If  the 
main  function  of  a  nurse  is  to  maintain  the  air  within  the  room  as 
fresh  as  the  air  without,  without  lowering  the  temperature,  then  she 
should  always  be  provided  with  a  thermometer  which  indicates  the 
temperature,  with  an  air-test  which  indicates  the  organic  matter  of  the 
air.  But  to  be  used,  the  latter  must  be  made  as  simple  a  little  instru- 
ment as  the  former,  and  both  should  be  self-registering.  The  senses 
of  nurses  and  mothers  become  so  dulled  to  foul  air,  that  they  are  per- 
fectly unconscious  of  what  an  atmosphere  they  have  let  their  children, 
patients,  or  charges,  sleep  in.  But  if  the  tell-tale  air-test  were  to  ex- 
hibit in  the  morning,  both  to  nurses  and  patients,  and  to  the  superior 
officer  going  round,  what  the  atmosphere  has  been  diiring  the  night,  I 
question  if  any  greater  security  could  be  afforded  against  a  recurrence 
of  the  misdemeanor. 

And  O,  the  crowded  national  school !  where  so  many  children's 
epidemics  have  their  origin,  what  a  tale  its  air-test  would  tell !  We 
should  have  parents  saying,  and  saying  rightly,  "  I  will  not  send 
my  child  to  that  school,  the  air-test  stands  at  '  Horrid.'  "  And  the 
dormitories  of  our  great  boarding  schools  !  Scarlet  fever  Avould  be  no 
more  ascribed  to  contagion,  but  to  its  right  cause,  the  air  test  standing 
at  '<Foul." 

We  should  hear  no  longer  of  "Mysterious  Dispensations,"  and  of 
"Plague  and  Pestilence,"  being  "  in  God's  hands,"  when,  so  far  as  we 
know.  He  has  put  them  into  oxir  own.  The  little  air-test  M'ould  both 
betray  the  cause  of  these  "  mysterious  pestilences,"  and  call  upon  us  to 
remedy  it. 


VENTILATION   AND   WARMING.  15 

from  minute  to  minute.  The  feet  and  legs  should  be  ex- 
amined by  the  hand  from  time  to  time,  and  whenever  a 
tendency  to  chilling  is  discovered,  hot  bottles,  hot  bricks, 
or  warm  flannels,  Avith  some  w^arm  drink,  sliould  be  made 
use  of  until  the  temperature  is  restored.  The  fire  should 
be,  if  necessary,  replenished.  Patients  are  frequently  lost 
hi  the  latter  stages  of  disease  from  w^ant  of  attention  to 
such  simple  precautions.  The  nurse  may  be  trusting  to 
the  patient's  diet,  or  to  his  medicine,  or  to  the  occa- 
sional dose  of  stimulant  wdiich  she  is  directed  to  give  him, 
while  the  patient  is  all  the  while  sinking  from  want  of  a 
little  external  warmth.  Such  cases  happen  at  all  times, 
CA'on  during  the  height  of  summer.  This  fatal  cliill  is  most 
apt  to  occur  tow'ards  early  morning  at  the  period  of  the 
lowest  temperature  of  the  twenty-four  hours,  and  at  the 
time  when  the  effect  of  the  preceding  day's  diets  is  ex- 
hausted. 

Generally  speaking,  you  may  expect  that  weak  patients 
w^ill  sufier  cold  much  more  in  the  morning  than  in  the 
evening.  The  vital  powers  are  much  lower.  If  they  are 
feverisli  at  night,  with  buniing  hands  and  feet,  they  are 
almost  sure  to  be  chilly  and  shivering  in  the  morning. 
But  nurses  are  very  fond  of  heating  the  foot-wanner  at 
night,  and  of  neglecting  it  in  the  morning,  when  they  are 
busy.     I  should  reverse  the  matter. 

All  these  things  require  common  sense  and  care.  Yet, 
perhaps,  in  no  one  single  thing  is  so  little  common  sense 
shown,  in  all  ranks,  as  in  nursing.* 

The  extraordinary  confusion  between  cold  and  ventila- 
tion, even  in  the  minds  of  Avell  educated  people,  illustrates 

AVith  private  sick,  I  think,  but  certainly  with  hospital  sick,  the 
nurse  should  never  be  satisfied  as  to  the  freshness  of  their  atmosphere, 
unless  she  can  feel  the  air  gently  moving  over  her  face,  Avhen  still. 

But  it  is  often  observed  that  the  nurses  Avho  make  the  greatest 
outcry  against  open  -windows,  are  those  who  take  the  least  pains  to 
prevent  dangerous  draughts.  The  door  of  the  patients'  room  or  waid 
mu^it  sometimes  stand  open  to  allow  of  persons  passing  in  and  out,  or 
heavy  things  being  carried  in  and  out.  The  carefiil  nurse  will  keep 
the  door  shut  while  she  shuts  the  windows,  and  tlien,  and  not  before, 
set  the  door  open,  so  that  a  patient  may  not  be  left  sitting  up  in  bed, 
perhaps  in  a  profuse  perspiration,  directly  in  the  draught  between  the 
open  door  and  window.  Neither,  of  course,  should  a  patient,  while 
being  washed  or  in  any  way  exposed,  remain  in  the  draught  of  an  open 
window  or  door. 


16  NOTES   ON  NURSING. 

this.  To  make  a  room  cold  is  by  no  means  necessarily  to 
ventilate  it.  Nor  is  it  at  all  necessary,  in  order  to  venti- 
late a  room,  to  chill  it.  Yet,  if  a  nurse  finds  a  room  close, 
she  will  let  out  the  fire,  thereby  making  it  closer,  or  she 
will  open  the  door  into  a  cold  room,  without  a  fire,  or  an 
open  window  in  it,  by  M'ay  of  improving  the  ventilation. 
The  safest  atmosphere  of  all  for  a  patient  is  a  good  fire 
and  an  open  window,  excepting  in  extremes  of  tempera- 
ture. (Yet  no  nurse  can  ever  be  made  to  understand 
this.)  To  ventilate  a  small  room  without  draughts  of 
course  requires  more  care  than  to  ventilate  a  large  one. 

Another  extraordinary  fallacy  is  the  dread  of  night  air. 
What  air  can  we  breathe  at  night  but  night  air?  The 
choice  is  between  pure  night  air  from  without  and  foul 
night  air  from  within.  Most  people  prefer  the  latter.  An 
unaccountable  choice.  What  will  they  say  if  it  is  proved 
to  be  true  that  fully  one-half  of  all  the  disease  we  suffer 
from  is  occasioned  by  people  sleeping  with  their  windows 
shut?  An  open  window  most  nights  in  the  year  can 
never  hurt  any  one.  This  is  not  to  say  that  light  is  not 
necessary  for  recovery.  In  great  cities,  night  air  is  often 
the  best  and  purest  air  to  be  had  in  the  twenty-four  hours. 
I  could  better  understand  in  towns  shutting  the  windows 
during  the  day  than  during  the  night,  for  the  sake  of  the 
sick.  The  absence  of  smoke,  the  quiet,  all  tend  to  making 
night  the  best  time  for  airing  the  patients.  One  of  our 
highest  medical  authorities  on  Consumption  and  Climate 
has  told  me  that  the  air  in  London  is  never  so  good  as 
after  ten  o'clock  at  night. 

Always  air  your  room,  then,  from  the  outside  air,  if  pos- 
sible. Windows  are  made  to  open ;  doors  are  made  to 
shut  —  a  truth  which  seems  extremely  difticult  of  appre- 
hension. I  have  seen  a  careful  nurse  airing  her  patient's 
room  though  the  door,  near  to  which  were  two  gaslights, 
(each  of  which  consumes  as  much  air  as  eleven  men,)  a 
kitchen,  a  corridor,  the  composition  of  the  atmosphere  in 
which  consisted  of  g&s,  paint,  foul  air,  never  changed,  full 
of  effluvia,  including  a  current  of  sewer  air  from  an  ill- 
placed  sink,  ascending  in  a  continual  stream  by  a  well- 
staircase,  and  discharging  themselves  constantly  into  the 
])atient's  room.  The  window  of  the  said  room,  if  opened, 
was  all  that  was  desirable  to  air  it.     Every  room  must  be 


VENTILATION  AND  WARMING.  17 

aired  from  without  —  every  passage  from  without.  But 
the  fewer  passages  there  are  in  a  hospital  the  better. 

If  we  are  to  preserve  the  air  within  as  pure  as  the  air 
without,  it  is  needless  to  say  that  the  chimney  must  not 
smoke.  Almost  all  smoky  chimneys  can  be  cured  —  from 
the  bottom,  not  from  the  top.  Often  it  is  only  necessary 
to  have  an  inlet  for  air  to  supply  the  tire,  which  is  feeding 
itself,  for  want  of  this,  from  its  own  chimney.  On  the 
other  hand,  almost  all  chimneys  can  be  made  to  smoke  by 
a  careless  nurse,  who  lets  the  fire  get  low  and  then  over- 
whelms it  with  coal ;  not,  as  we  verily  believe,  in  order  to 
spare  herself  trouble,  (for  very  rare  is  unkindness  to  the 
sick,)  but  from  not  thinking  what  she  is  about. 

In  laying  down  the  principle  that  the  first  object  of  the 
nurse  must  be  to  keep  the  air  breathed  by  her  patient  as 
pure  as  the  air  without,  it  must  not  be  forgotten  that 
every  thing  in  the  room  which  can  give  off  effluvia,  be- 
sides the  patient,  evaporates  itself  into  his  air.  And  it 
follows  that  there  ought  to  be  nothing  in  the  room,  ex- 
cepting him,  which  can  give  off  effluvia  or  moisture.  Out 
of  all  damp  towels,  &c.,  which  become  dry  in  the  room, 
the  damp,  of  course,  goes  into  the  patient's  air.  Yet  this 
"  of  course  "  seems  as  little  thought  of,  as  if  it  were  an  ob- 
solete fiction.  How  very  seldom  you  see  a  nurse  who 
acknowledges  by  her  practice  that  nothing  at  all  ought  to 
be  aired  in  the  patient's  room,  that  nothing  at  all  ought  to 
be  cooked  at  the  patient's  fire !  Indeed  the  arrangements 
often  make  this  rule  impossible  to  observe. 

If  the  nurse  be  a  very  careful  one,  she  will,  when  the 
patient  leaves  his  bed,  but  not  his  room,  open  the  sheets 
wide,  and  throw  the  bed-clothes  back,  in  order  to  air  his 
bed.  And  she  will  spread  the  wet  towels  and  flannels 
carefully  out  upon  a  horse,  in  order  to  dry  them.  Now 
either  these  bed-clothes  and  towels  are  not  dried  and  aired, 
or  they  dry  and  air  themselves  into  the  patient's  air.  And 
whether  the  damp  and  effluvia  do  him  most  harm  in  his 
air  or  in  his  bed,  I  leave  to  you  to  determine,  for  I  cannot. 

Even  in  health  people  cannot  repeatedly  breathe  air  in 
which  they  live  with  impunity,  on  account  of  its  becoming 
charged  with  unwholesome  matter  from  the  lungs  and 
skin.  In  disease  where  every  thing  given  off  from  the 
body  is  highly  noxious  and  dangerous,  not  only  must  there 
be  plenty  of  ventilation  to  carry  ofl:*  the  effluvia,  but  every 
2* 


18  NOTES   ON   NURSING. 

thing  which  the  patient  passes  must  be  instantly  removed 
away,  as  being  more  noxious  than  even  the  emanations 
from  tlie  sick. 

Of  the  fatal  effects  of  the  effluvia  from  the  excreta  it 
would  seem  unnecessary  to  speak,  were  they  not  so  con- 
stantly neglected.  Concealing  the  utensils  behind  the 
vallance  to  the  bed  seems  all  the  precaution  which  is 
thought  necessary  for  safety  in  private  nursing.  Did  you 
but  think  for  one  moment  of  the  atmosjihere  under  that 
bed,  the  saturation  of  the  under  side  of  the  mattress  with 
the  warm  evaporations,  you  would  be  startled  and  fright- 
ened too ! 

The  use  of  any  chamber  utensil  vnthoiit  a  lid*  should 
be  utterly  abolished,  whether  among  sick  or  well.  You  can 
easily  convince  yourself  of  the  necessity  of  this  absolute 
rule,  by  taking  one  with  a  lid,  and  examining  the  under 
side  of  that  lid.  It  will  be  found  always  covered,  when- 
ever the  utensil  is  not  empty,  by  condensed  offensive  mois- 
ture.    Where  does  that  go,  when  there  is  no  lid  ? 

Earthenware,  or  if  there  is  any  wood,  highly  polished 
and  varnished  wood,  are  the  only  materials  fit  for  patients' 

*  But  never,  never  should  the  possession  of  this  indispensable  lid 
confirm  you  in  the  abominable  practice  of  letting  the  chamber  utensil 
remain  in  a  patient's  room  unemptied,  except  once  in  the  24  hours,  i.  e., 
when  the  bed  is  made.  Yes,  impossible  as  it  may  appear,  I  have 
known  the  best  and  most  attentive  nurses  guilty  of  this  ;  ay,  and 
have  known,  too,  a  patient  afflicted  with  severe  diarrhoea  for  ten  days, 
and  the  nurse  (a  very  good  one)  not  know  of  it,  because  the  chamber 
utensil  (one  with  a  lid)  was  emptied  only  once  in  24  hours,  and  that 
by  the  housemaid  who  came  in  and  made  the  patient's  bed  every 
evening.  As  well  might  you  have  a  sewer  under  the  room,  or  think 
that  in  a  water-closet  the  plug  need  be  pulled  up  but  once  a  day.  ALso 
take  care  that  your  lid,  as  well  as  your  utensil,  be  always  thoroughly 
rinsed. 

K  a  nurse  declines  to  do  these  kinds  of  things  for  her  patient,  "  be- 
cause it  is  not  her  business,"  I  should  say  that  nursing  was  not  her 
calling.  I  have  seen  surgical  "  sisters,"  women  whose  hands  were 
■worth  to  them  two  or  three  guineas  a- week,  down  upon  their  knees 
scouring  a  room  or  hut,  because  they  thought  it  otherwise  not  fit  for 
their  patients  to  go  into.  I  am  far  from  wishing  nurses  to  scour.  It 
is  a  waste  of  power.  But  I  do  say  that  these  women  had  the  true 
nurse-calling  —  the  good  of  their  sick  first,  and  second  only  the  con- 
sideration what  it  was  their  "place"  to  do  —  and  that  women  who 
wait  for  the  housemaid  to  do  this,  or  for  the  charwoman  to  do  that, 
when  their  patients  are  suffering,  have  not  the  making  of  a  nurse  in 
them. 


HEALTH    OF    HOUSES.  19 

utensils.  The  very  lid  of  the  old  abominable  close-stool  is 
enough  to  breed  a  pestilence.  It  becomes  saturated  with 
offensive  matter,  which  scouring  is  only  Avanted  to  bring 
out.  I  prefer  an  earthenware  lid  as  being  always  cleaner. 
But  there  are  various  good  new-fashioned  arrangements. 

A  slop-pail  should  never  be  brouglit  into  a  sick  room.  It 
should  be  a  rule  invariable,  rather  more  important  in  the 
private  house  than  elsewhere,  that  the  utensil  should  be 
carried  directly  to  the  water-closet,  emptied  there,  rinsed 
there,  and  brouglit  back."  There  should  always  be  water 
and  a  cock  in  every  water-closet  for  rinsing.  But  even  if 
there  is  not,  you  must  carry  water  there  to  rinse  with.  I 
have  actually  seen,  in  the  private  sick  room,  the  utensils 
emptied  into  the  foot-pan,  and  put  back  unrinsed  under  the 
bed.  I  can  hardly  say  which  is  most  abominable,  wlietlier 
to  do  this  or  to  rinse  the  untensil  i)i  the  sick  room.  In  the 
best  hospitals  it  is  now  a  rule  that  no  slop-pail  shall  ever  be 
brought  into  the  wards,  but  that  the  utensils  shall  be  car- 
ried direct  to  be  emptied  and  rinsed  at  the  proper  place. 
I  would  it  were  so  in  the  private  house. 

Let  no  one  ever  depend  upon  fumigations,  "disinfect- 
ants," and  the  like,  for  purifying  the  air.  The  offensive 
thing,  not"  its  smell,  must  be  removed.  A  celebrated  medi- 
cal lecturer  began  one  day,  "  Fumigations,  gentlemen,  are 
of  essential  importance.  They  make  such  an  abominable 
smell  that  they  compel  you  to  open  the  window."  I  wish' 
all  the  disinfecting  fluids  invented  made  such  an  "  abomina- 
ble smell "  that  they  forced  you  to  admit  fresh  air.  That 
would  be  a  useful  invention. 


HEALTH  OF  HOUSES.* 


There 

are 

five 

essential  points 

in  securing 

the 

health  of 

houses : - 

1. 

2. 

Pure  air. 
Pure  water. 

s! 

Eflicient  drainage. 

4. 

Cleanliness. 

5. 

Lio-ht. 

*  The  health  of  carriages,  especially  close  carriages,  is  not  of  suffi- 
cient universal  importance  to  mention  here,  otherwise  than  cursorily. 
Children,  who  are  always  the  nioit  delicate  test  of  sanitary  oouditiuns, 


20  NOTES   ON  NURSING. 

Without  these,  no  house  can  be  healthy.  And  it  will  be 
unhealthy  just  in  proportion  as  they  are  deficient. 

1.  To  have  pure  air,  your  house  must  be  so  constructed  as 
that  the  outer  atmos]:>here  shall  find  its  way  with  ease  to 
every  corner  of  it.  House  architects  hardly  ever  consider 
this.  The  object  in  building  a  house  is  to  obtain  the  largest 
interest  for  the  money,  not  to  save  doctors'  bills  to  the  ten- 
ants. But,  if  tenants  should  ever  become  so  wise  as  to 
refuse  to  occupy  unhealthy  constructed  houses,  and  if 
Insurance  Companies  should  ever  come  to  understand  their 
interest  so  thoroughly  as  to  pay  a  Sanitary  Surveyor  to 
look  after  the  houses  where  their  clients  live,  speculative 
architects  would-  speedily  be  brought  to  their  senses.  As 
it  is,  they  build  what  pays  best.  And  there  are  always 
people  foolish  enough  to  take  the  houses  they  build.  And 
if  in  the  course  of  time  the  families  die  off,  as  is  so  often 
the  case,  nobody  ever  thinks  of  blaming  any  but  Provi- 
dence *  for  the  result.  Ill-informed  medical  men  aid  in 
sustaining  the  delusion,  by  laying  the  blame  on  "  current 
contagions."  Badly  constructed  houses  do  for  the  healthy 
wdiat  badly  constructed  hospitals  do  for  the  sick.  Once 
insure  that  the  air  in  a  house  is  stagnant,  and  sickness  is 
certain  to  follow. 

2.  Pure  water  is  more  generally  introduced  into  houses 
than  it  used  to  be,  thanks  to  the  exertions  of  the  sanitary 
reformers.  Within  the  last  few  years,  a  large  part  of  Lon- 
don was  in  the  daily  habit  of  using  water  polluted  by  the 
drainage  of  its  sewers  and  water-closets.  This  has  happily 
been  remedied.     But,  in  many  j^arts  of  the  country,  well 

generally  cannot  enter  a  close  carriage  without  being  sick  —  and  very- 
lucky  for  them  that  it  is  so.  A  close  carriage,  with  the  horse-hair 
cushions  and  linings  always  saturated  with  organic  matter,  if  to  this 
be  added  the  windows  up,  is  one  of  the  most  unhealthy  of  human 
receptacles.  The  idea  of  taking  an  airing  in  it  is  something  preposter- 
ous. Dr.  Angus  Smith  has  shown  that  a  crowded  railway  carriage, 
which  goes  at  the  rate  of  30  miles  an  hour,  is  as  unwholesome  as  the 
strong  smell  of  a  sewer,  or  as  a  back  yard  in  one  of  the  most  un- 
healthy courts  off  one  of  the  most  unhealthy  streets  in  ^lanchester. 

*  God  lays  down  certain  physical  laws.  Upon  his  carrying  out 
such  laws  depends  our  responsibility  (that  much  abused  word),  for 
how  could  we  have  any  I'esponsibility  for  actions,  the  results  of  which 
we  could  not  foresee  —  which  would  be  the  case  if  the  carrying  out  of 
His  laws  were  not  certain.  Yet  we  seem  to  be  continually  expecting 
that  he  will  work  a  miracle  —  i.  e.,  break  His  own  laws  expressly  to 
relieve  us  of  responsibility. 


HEALTH   OP   HOUSES.  21 

water  of  a  very  impure  kind  is  used  for  domestic  purposes. 
And  when  epidemic  disease  shows  itself,  persons  using 
such  water  are  almost  sure  to  suffer. 

3.  It  would  be  curious  to  ascertain  by  inspection,  how 
many  houses  in  London  are  really  well  drained.  JVIany 
people  Avould  say,  surely  all  or  most  of  them.  But  many 
people  have  no  idea  in  what  good  drainage  consists. 
They  think  that  a  sewer  in  the  street,  and  a  pipe  leading 
to  it  from  the  house,  is  good  drainage.  All  the  while  the 
sewer  may  be  nothing  but  a  laboratory  from  which  epi- 
demic disease  and  ill  health  is  being  distilled  into  the  house. 
No  house  with  any  untrapped  drain  pipe  communicating 
immediately  with  a  sewer,  whether  it  be  from  water-closet, 
sink,  or  gully-grate,  can  ever  be  healthy.  An  untrapped 
sink  may  at  any  time  spread  fever  or  pyaemia  among  the 
inmates  of  a  palace. 

The  ordinary  oblong  sink  is  an  abomination.  That  great 
surface  of  stone,  which  is  always  left  wet,  is  always  exhaling 
into  the  air.  I  have  known  whole  houses  and  hospitals 
smell  of  the  sink.  I  have  met  just  as  strong  a  stream  of 
sewer  air  coming  up  the  back  staircase  of  a  grand  London 
house  from  the  sink,  as  I  have  ever  met  at  Scutari;  and  I 
have  seen  the  rooms  in  that  house  all  ventilated  by  the 
open  doors,  and  the  passages  all  i^??ventilated  by  the  closed 
windows,  in  order  that  as  much  of  the  sewer  air  as  possible 
might  be  conducted  into  and  retained  in  the  bed-rooms. 
It  is  wonderful. 

Another  great  evil  in  house  construction  is  carrying 
drains  underneath  the  house.  Such  drains  are  never  safe. 
All  house  drains  should  begin  and  end  outside  the  walls. 
Many  people  will  readily  admit,  as  a  theory,  the  importance 
of  these  things.  But  how  few  are  there  who  can  intelli- 
gently trace  disease  in  their  households  to  such  causes! 
Is  it  not  a  fact,  that  Avlien  scarlet  fever,  measles,  or  small- 
pox appear  among  the  children,  the  very  first  thought 
which  occurs  is,  "  where  "  the  children  can  have  "  caught " 
the  disease?  And  the  parents  immediately  run  over  in 
their  minds  all  the  families  with  whom  they  may  have 
been.  They  never  think  of  looking  at  home  for  the  source 
of  the  mischief  If  a  neighbor's  child  is  seized  with  small- 
pox, the  first  question  which  occurs  is  whether  it  had  been 
vacchiated.  No  one  would  undervalue  vaccination ;  but 
it  becomes  of  doubtful  benefit  to  societv  when  it  leads 


22  NOTES   ON   NURSING. 

people  to  look  abroad  for  the  source  of  evils  which  exist  at 
home. 

4.  Without  cleanliness,  Avithin  and  without  your  house, 
ventilation  is  comparatively  useless.  In  certain  foul  dis- 
tricts of  London,  poor  people  used  to  object  to  open  their 
windows  and  doors  because  of  the  foul  smells  that  came  in. 
Rich  people  like  to  have  their  stables  and  dunghill  near 
their  houses.  But  does  it  ever  occur  to  them  that  with 
many  an-angements  of  this  kind  it  would  be  safer  to  keep 
tlie  windows  shut  than  open  ?  You  cannot  have  the  air 
of  the  house  pure  with  dung-heaps  under  the  windows. 
These  are  common  all  over  London.  And  yet  people  are 
surprised  that  their  children,  brought  up  in  large  "  well- 
aired"  nurseries  and  bed-rooms  suffer  from  children's  epi- 
demics. If  they  studied  Nature's  laws  in  the  matter  of 
children's  health,  they  would  not  be  so  surprised. 

There  are  other  ways  of  having  filth  inside  a  house 
besides  having  dirt  in  heaps.  Old  papered  walls  of  years' 
standing,  dirty  carpets,  uncleansed  furniture,  are  just  as 
ready  sources  of  impurity  to  the  air  as  if  there  were  a  dung- 
heap  in  the  basement.  People  are  so  unaccustomed  from 
education  and  habits  to  consider  how  to  make  a  home 
healthy,  that  they  either  never  think  of  it  at  all,  and  take 
every  disease  as  a  matter  of  course,  to  be  "  resigned  to " 
when  it  comes  "  as  from  the  hand  of  Providence ; "  or  if 
they  ever  entertain  the  idea  of  preserving  the  health  of 
their  household  as  a  duty,  they  are  very  apt  to  commit  all 
kinds  of  " negligences  and  ignorances"  in  performing- it. 

5.  A  dark  house  is  always  an  unhealthy  house,  always 
an  ill-aired  house,  always  a  dirty  house.  Waut  of  light 
stops  growth,  and  jDromotes  scrofula,  rickets,  &c.,  among 
the  children. 

People  lose  their  health  in  a  dark  house,  and  if  they  get 
ill  they  cannot  get  well  again  in  it.  More  will  be  said 
about  this  farther  on. 

Three  out  of  many  "negligences  and  ignorances"  in 
managing  the  health  of  houses  generally,  I  will  here  men- 
tion as  specimens  —  1.  That  the  female  head  in  charge  of 
any  building  does  not  think  it  necessary  to  visit  every  hole 
and  corner  of  it  every  day.  How  can  she  expect  those 
who  are  under  her  to  be  more  careful  to  maintain  her  house 
in  a  healthy  condition  than  she  who  is  in^  charge  of  it  ?  — • 
2.   That  it  is  not  considered  essential  to  air,  to  sun,  and  to 


HEALTH   OP   HOUSES.  23 

clean  rooms  while  uninhabited ;  which  is  simply  ignoring 
the  first  elementary  notion  of  sanitary  things,  and  laying 
the  ground  ready  for  all  kinds  of  diseases.  —  3.  That  the 
window,  and  one  window,  is  considered  enough  to  air  a 
room.  Have  you  never  observed  tliat  any  room  without  a 
fire-place  is  always  close  ?  And,  if  you  have  a  fire-place, 
would  you  cram  it  up  not  only  with  a  chimney-board,  but 
perhaps  with  a  great  wisp  of  brown  paper,  in  the  throat  of 
the  chimney  —  to  prevent  the  soot  from  coming  down,  you 
say  ?  If  your  chimney  is  foul,  sweep  it ;  but  don't  expect 
that  you  can  ever  air  a  room  with  only  one  aperture ;  don't 
suppose  that  to  shut  up  a  room  is  the  way  to  keep  it  clean. 
It  is  the  best  way  to  foul  the  room  and  all  that  is  in  it. 
Don't  imagine  that  if  you,  who  are  in  charge,  don't  look  to 
all  these  things  yourself,  those  under  you  will  be  more 
careful  than  you  are.  It  appears  as  if  the  part  of  a  mistress 
now  is  to  complain  of  her  servants,  and  to  accept  their 
excuses  —  not  to  show  them  how  there  need  be  neither 
complaints  made  nor  excuses. 

But  again,  to  look  to  all  these  things  yourself  does  not 
mean  to  do  them  yourself.  "  I  always  open  the  windows," 
the  head  in  charge  often  says.  If  you  do  it,  it  is  by  so 
much  the  better,  certainly,  than  if  it  were  not  done  at  all. 
But  can  you  not  insure  that  it  is  done  when  not  done  by 
yourself?  Can  you  insure  that  it  is  not  undone  when  your 
back  is  turned  ?  This  is  what  being  "  in  charge  "  means. 
And  a  very  important  meaning  it  is,  too.  The  former 
only  implies  that  just  what  you  can  do  with  your  own 
hands  is  done.  The  latter  that  what  ought  to  be  done  is 
always  done. 

And  now,  you  think  these  things  trifles,  or  at  least  exag- 
gerated. But  what  you  "think"  or  what  I  "think"  mat- 
ters little.  Let  us  see  what  God  thinks  of  them.  God 
always  justifies  His  ways*  While  we  are  thinking,  he  has 
been  teaching.  I  have  known  cases  of  hospital  pyaemia 
quite  as  severe  in  handsome  private  houses  as  in  any  of 
the  worst  hospitals,  and  from  the  same  cause,  viz.,  foul  air. 
Yet  nobody  learnt  the  lesson.  Nobody  learnt  any  thing 
at  all  from  it.  They  went  on  thinJdng  —  thinking  that  the 
sufferer  scratched  his  thumb,  or  that  it  was  singular  that 
"  all  the  servants  "  had  "  whitlows  "  or  that  something  was 
"much  about  this  year;  there  is  always  sickness  in  our 
house."     This  is  a  favorite  mode  of  thought  —  leading  not 


24  NOTES   ON   NURSING. 

to  iuqnire  what  is  the  uniform  cause  of  these  general 
"whitlows,"  but  to  stifle  all  inquiry.  In  what  sense  is 
"  sickness  "  being  "  always  there,"  a  justification  of  its  being 
"there"  at  all? 

I  will  tell  you  what  was  the  cause  of  this  hospital  pyae- 
mia being  in  that  large  private  house.  It  was  that  the 
sewer  air  from  an  ill-placed  sink  was  carefully  conducted 
into  all  the  rooms  by  sedulously  opening  all  the  doors,  and 
closing  all  the  passage  windows.  It  was  that  the  slops 
were  emptied  into  the  foot-pans!  —  it  was  that  the  utensils 
were  never  properly  rinsed;  —  it  was  that  the  chamber 
crockery  was  rinsed  with  dirty  water;  —  it  was  that  the 
beds  were  never  properly  shaken,  aired,  picked  to  pieces, 
or  changed.  It  was  that  the  carpets  and  curtains  were 
always  musty;  —  it  was  that  the  furniture  was  always 
dusty ;  —  it  was  that  the  papered  walls  were  saturated  with 
dirt ;  —  it  was  that  the  floors  were  never  cleaned ;  —  it  was 
that  the  uninhabited  rooms  were  never  sunned,  or  cleaned, 
or  aired;  —  it  was  that  the  cupboards  were  always  reser- 
voirs of  foul  air;  —  it  Avas  that  the  windows  were  always 
tight  shut  up  at  night ;  —  it  was  that  no  window  was  ever 
systematically  opened  even  in  the  day,  or  that  the  right 
window  was  not  opened.  A  person  gasping  for  air  might 
open  a  window  for  himself.  But  the  servants  were  not 
taught  to  open  the  windows,  to  shut  the  doors ;  or  they 
opened  the  windows  upon  a  dank  well  between  high  walls, 
not  upon  the  airier  court ;  or  they  opened  the  room  doors 
into  the  unaired  halls  and  passages,  by  way  of  airing  the 
rooms.  IS^ow  all  this  is  not  fancy,  but  fact.  In  that  hand- 
some house  I  have  known  in  one  summer  three  cases  of 
hospital  pyemia,  one  of  phlebitis,  two  of  consumptive 
cough;  all  the  imtnediate  j^roducts  of  foul  air.  When,  in 
temperate  climates,  a  house  is  more  unhealthy  ui  summer 
than  in  winter,  it  is  a  certain  sign  of  something  wrong; 
Yet  nobody  learns  the  lesson.  Yes,  God  always  justifies 
His  ways.  He  is  teaching  while  you  are  not  learning.  This 
poor  body  loses  his  finger,  that  one  loses  his  life.  And  all 
from  the  most  easily  j^reventable  causes.* 

*  I  must  say  a  -word  about  servants'  bed-rooms.  From  the  way 
they  are  built,  but  oftener  from  the  way  they  are  kept,  and  from  no 
intelligent  inspection  whatever  being  exercised  over  them,  they  are  al- 
most invariably  dens  of  foul  air,  and  the  «'  servants'  health"  suffers  in 
an  «'  unaccountable  "  (?)  way,  even  in  the  country.     For  I  am  by  no 


HEALTH  OF   HOUSES.  25 

The  houses  of  the  grandmothers  and  great  grandmoth- 
ers of  this  generation,  at  least  the  country  houses,  with 
front  door  and  back  door  always  standing  open,  winter 
and  summer,  and  a  tliorou<>-h  drauo-ht  always  •  blowinor 
through  —  with  all  the  scrubbing,  and  cleaning,  and  pol- 
ishing, and  scouring  which  used  to  go  on,  the  grandmoth- 
ers, and  still  more  the  great  grandmothers,  always  out  of 
doors  and  never  with  a  bonnet  on  except  to  go  to  church, 
these  things  entirely  account  for  the  fact  so  often  seen  of 
a  great  grandmother,  who  was  a  tower  of  physical  vigor, 
descending  into  a  grandmother  perhaps  a  little  less  vigor- 
rous  but  still  sound  as  a  bell  and  healthy  to  the  core,  into 
a  mother  languid  and  confined  to  her  carriage  and  house, 
and  lastly  into  a  daughter  sickly  and  confined  to  her  bed. 
For,  remember,  even  with  a  general  decrease  of  mortality, 
you  may  often  find  a  race  thus  degenerating  and  still  oft- 
ener  a  family.  You  may  see  poor  little  feeble  washed-out 
rags,  children  of  a  noble  stock,  suffering  morally  and  physi- 
cally, throughout  their  useless,  degenerate  lives,  and  yet 
people  who  are  going  to  marry  and  to  bring  more  such 
into  the  world,  will  consult  nothing  but  their  own  conven- 
ience as  to  where  they  are  to  live,  or  how  they  are  to  live. 

"With  regard  to  the  health  of  houses  where  there  is  a 
sick  person,  it  often  happens  that  the  sick  room  is  made  a 
ventilating  shaft  for  the  rest  of  the  house.  For  while  the 
house  is  kept  as  close,  unaired,  and  dirty  as  usual,  the  win- 
dow of  the  sick  room  is  kept  a  little  open  always,  and  the 
door  occasionally.  Now,  there  are  certain  sacrifices  which 
a  house  with  one  sick  person  in  it  does  make  to  that  sick 
person :  it  ties  up  its  knocker ;  it  lays  straw  before  it  in 
the  street.  Why  can't  it  keep  itself  thoroughly  clean  and 
unusually  well  aired,  in  deference  to  the  sick  person  ? 

We  must  not  forget  what,  in  ordinary  language,  is  called 
"Infection;"*  —  a  thing  of  which  peoj^le  are  generally  so 

means  speaking  only  of  London  houses,  where  too  often  servants  jjre 
put  to  live  under  tlio  ground  and  over  the  roof.  But  in  a  country 
"  mansion"  which  was  really  a  "jnansion,"  (not  after  the  fashion  of 
advertisements,)  I  have  known  three  maids  who  slept  in  the  same 
room  ill  of  scarlet  fever.  "  Hoav  catching  it  is,"  was  of  course  the 
remark.  One  look  at  the  room,  one  smell  of  the  room,  was  quite 
enough.  It  was  no  longer  «'  unaccountable."  The  room  Avas  not  a 
small  one ;  it  was  up  stairs,  and  it  had  two  large  windows  —  but 
nearlj''  every  one  of  the  neglects  enumerated  above  was  there. 

*  Is  it  not  living  in  a  continual  mistake  to  look  upon  discuses,  as  wq 

3 


26  NOTES  ON  NURSING. 

afraid  that  they  frequently  follow  the  very  practice  in  re- 
gard to  it  which  they  ought  to  avoid.  Nothing  used  to 
be  considered  so  infectious  or  contagious  as  small-pox ;  and 
people  not  very  long  ago  used  to  cover  up  patients  with 
heavy  bed  clothes,  while  they  kept  up  large  fires  and  shut 
the  windows.  Small-pox,  of  course,  under  this  regime^  is 
very  "infectious."  People  are  somewhat  wiser  now  in  their 
management  of  this  disease.  They  have  ventured  to  cov- 
er the  23atients  lightly  and  to  keep  the  windows  open ;  and 
we  hear  much  less  of  the  "infection"  of  small-pox  than 
we  used  to  do.  But  do  people  in  our  days  act  with  more 
wisdom  on  the  subject  of  "infection"  in  fevers — scarlet 
fever,  measles,  &c.  —  than  their  forefathers  did  with  small- 
pox? Does  not  the  popular  idea  of  "infection"  involve 
that  people  should  take  greater  care  of  themselves  than  of 
the  patient  ?  that,  for  instance,  it  is  safer  not  to  be  too 
much  with  the  patient,  not  to  attend  too  much  to  his  wants? 
Perhaps  the  best  illustration  of  the  utter  absurdity  of  this 
view  of  duty  in  attending  on  "infectious"  diseases  is  af- 
forded by  what  was  very  recently  the  practice,  if  it  is  not 
80  even  now,  in  some  of  the  European  lazarets  —  in  which 
the  plague-patient  used  to  be  condemned  to  the  horrors  of 

do  now,  as  separate  entities,  which  jymst  exist,  like  cats  and  dogs  ? 
instead  of  looking  upon  them  as  conditions,  like  a  dirty  and  a  clean  con- 
dition, and  just  as  much  under  our  own  control ;  or  rather  as  the 
reactions  of  kindly  nature,  against  the  conditions  in  which  we  have 
placed  ourselves. 

I  was  brought  up,  both  by  scientific  men  and  ignorant  women,  dis- 
tinctly to  believe  that  small-pox,  for  instance,  was  a  thing  of  which 
there  was  once  a  first  specimen  in  the  world,  which  went  on  propa- 
gating itself,  in  a  perpetual  chain  of  descent,  just  as  much  as  that  there 
was  a  first  dog,  (or  a  first  pair  of  dogs,)  and  that  small-pox  would  not 
begin  itself  any  more  than  a  new  dog  would  begin  without  there  hav- 
ing been  a  parent  dog. 

Since  then  I  have  seen  with  my  eyes  and  smelt  ■vv'ith  my  nose  small- 
pox growing  up  in  first  specimens,  either  in  close  rooms,  or  in  over- 
crowded wards,  where  it  could  not  by  any  possibility  have  been 
*'  caught,"  but  must  have  begun. 

Nay,  more,  I  have  seen  diseases  begin,  grow  up,  and  pass  into  one 
another.     Now,  dogs  do  not  pass  into  cats. 

I  have  seen,  for  instance,  with  a  little  overcrowding,  continued  fever 
grow  up  ;  and  with  a  little  more,  typhoid  fever  ;  and  with  a  little  more, 
typhus,  and  all  in'  the  same  ward  or  hut. 

Would  it  not  be  far  better,  truer,  and  more  practical,  if  we  looked 
upon  disease  in  this  light  ? 

For  diseases,  as  all  experience  shows,  are  adjectives,  not  noun 
eubstantives. 


PETTY   MANAGEMENT.  27 

filth,  overcrowding,  and  want  of  ventilation,  while  the 
medical  attendant  was  ordered  to  examine  the  patient's 
tongue  through  an  opera-glass  and  to  toss  bini  a  lancet  to 
open  his  abscesses  with! 

True  nursing  ignores  infection,  except  to  prevent  it. 
Cleanliness  and  fresh  air  from  open  windows,  with  unre- 
mitting attention  to  the  patient,  are  the  only  defence  a 
true  nurse  either  asks  or  needs. 

Wise  and  humane  management  of  the  patient  is  the  best 
safeguard  against  infection. 

There  are  not  a  few  popular  opinions,  in  regard  to  which 
it  is  useful  at  times  to  ask  a  question  or  two.  For  exam- 
ple, it  is  commonly  thought  that  children  must  have  what 
are  commonly  called  "children's  epidemics,"  "current  con- 
tagions," &c.,  in  other  words,  that  they  are  born  to  have 
measles,  hooping-cough,  perhaps  even  scarlet  fever,  just  as 
they  are  born  to  cut  their  teeth,  if  they  live. 

Now,  do  tell  us,  why  must  a  child  have  measles  ? 

O,  because,  you  say,  we  cannot  keep  it  from  infection — 
other  children  have  measles  —  and  it  must  take  them  — 
and  it  is  safer  that  it  should. 

But  why  must  other  children  have  measles?  And  if 
they  have,  why  must  yours  have  them  too  ? 

If  you  believed  in  and  observed  the  laws  for  preserving 
the  health  of  houses  which  inculcate  cleanliness,  ventila- 
tion, white-washing,  and  other  means,  and  which,  by  the 
way,  are  Iciims^  as  implicitly  as  you  believe  in  the  popular 
opinion,  for  it  is  nothing  more  than  an  opinion,  that  your 
child  must  have  children's  epidemics,  don't  you  think  that 
upon  the  whole  your  child  would  be  more  likely  to  escape 
aW'ogether? 

m.    PETTY  MANAGEMENT. 

All  the  results  of  good  nursing,  as  detailed  in  these 
notes,  may  be  spoiled  or  utterly  negatived  by  one  defect, 
viz. :  in  petty  management,  or  in  other  words,  by  not 
knowing  how  to  manage  that  what  you  do  when  you  are 
there,  shall  be  done  when  you  are  not  there.  The  most 
devoted  friend  or  nurse  cannot  be  always  there.  Nor  is  it 
desirable  that  she  should.  And  she  may  give  up  her  health, 
all  her  other  duties,  and  yet,  for  want  of  a  little  manage- 
ment, be  not  one-hah['  so  efficient  a^  another  who  is  not 


28  NOTES   ON   NURSING. 

one-lialf  so  devoted,  but  "wlio  has  this  art  of  multiplying 
herself — that  is  to  say,  the  patient  of  the  first  will  not 
really  be  so  well  cared  for,  as  the  patient  of  the  second. 

It  is  as  ini])ossible  in  a  book  to  teach  a  person  in  charge 
of  sick  how  to  manage^  as  it  is  to  teach  her  how  to  nurse. 
Circumstances  must  vary  with  each  different  case.  But  it 
is  possible  to  press  upon  her  to  think  for  herself:  Now 
what  does  happen  during  my  absence  ?  I  am  obliged  to 
be  away  on  Tuesday.  But  fresh  air,  or  punctuality,  is  not 
less  important  to  my  patient  on  Tuesday  than  it  was  on 
Monday.  Or:  At  10  p.m.  I  am  never  with  my  patient; 
but  quiet  is  of  no  less  consequence  to  him  at  10  than  it 
w^as  at  5  minutes  to  10. 

Curious  as  it  may  seem,  this  very  obvious  consideration 
occurs  comparatively  to  few,  or,  if  it  does  occlir,  it  is  only 
to  cause  the  devoted  friend  or  nurse  to  be  absent  fewer 
hours  or  fewer  minutes  from  her  patient — not  to  arrange 
so  as  that  no  minute  and  no  hour  shall  be  for  her  patient 
without  the  essentials  of  her  nursing. 

A  very  few  instances  will  be  suflicient,  not  as  precepts, 
but  as  illustrations. 

A  strange  washerwoman,  coming  late  at  night  for  the 
"  things,"  will  burst  in  by  mistake  to  the  patient's  sick- 
room, after  he  has  fallen  into  his  first  doze,  giving  him  a 
shocks  the  effects  of  which  are  irremediable,  though  he 
himself  laughs  at  the  cause,  and  p>robably  never  even  men- 
tions it.  The  nurse  who  is,  and  is  quite  right  to  be,  at  her 
supper,  has  not  provided  that  the  washerwoman  shall  not 
lose  her  way  and  go  into  the  wrong  room. 

The  patient'^s  room  may  always  have  the  window  open. 
But  the  passage  outside  the  patient's  room,  though  pfb- 
vided  with  several  large  windows,  may  never  have  one 
open.  Because  it  is  not  understood  that  the  charge  of  the 
sick-room  extends  to  the  charge  of  the  passage.  And  thus, 
as  often  happens,  the  nui^e  makes  it  her  business  to  turn 
the  patient's  room  into  a  ventilating  shaft  for  the  foul  air  of 
the  whole  house. 

An  uninhabited  ix)om,  a  nevrly-painted  room,*  an  un- 

*  That  f'xoellent  paper,  the  Builder,  mentions  the  lingering  of  the 
smell  of  paint  for  a  month  about  a  house  as  a  proof  of  want  of  ventila- 
tion. Certainly  —  and,  where  there  are  ample  Avindows  to  open,  and 
these  are  never  opened  to  get  rid  of  the  smell  of  paint,  it  is  a  proof  of 
want  of  management  in  using  the  means  of  ventilation.  Of  course  the 
smell  will  then  remaiu  for  months.     WTiy  should  it  go  ? 


PETTY  MANAGEMENT.  29 

cleaned  closet  or  cupboard,  may  often  become  the  reser- 
Toir  of  foul  air  for  the  whole  house,  because  the  person  in 
charge  never  thinks  of  arranging  that  these  j^laces  shall 
be  always  aired,  always  cleaned;  she  merely  oi^cns  the 
window  herself  "  when  she  goes  in." 

An  agitating  letter  or  message  may  be  delivered,  or  an 
important  letter  or  message  not  delivered ;  a  visitor  whom 
it  was  of  consequence  to  see,  may  be  refused,  or  one  whom 
it  was  of  still  more  consequence  to  7iot  see  may  be  admitted 
— because  the  person  in  charge  has  never  asked  herseh 
this  question,  What  is  done  when  I  am  not  there  ?  * 

At  all  events,  one  may  safely  say,  a  nurse  cannot  be 
with  the  patient,  open  the  door,  eat  her  meals,  take  a  mes- 
sage, all  at  one  and  the  same  time.  Nevertheless  the  per- 
son in  charge  never  seems  to  look  the  impossibility  in  the 
face. 

Add  to  this  that  the  attempting  this  impossibihty  does 
more  to  increase  the  poor  patient's  hurry  and  nervousnesss 
than  anything  else. 

It  is  never  thought  that  the  patient  remembers  these 
things  if  you  do  not.  He  has  not  only  to  think  whether 
the  visit  or  letter  may  arrive,  but  whether  you  will  be  in 
the  way  at  the  particular  day  and  hour  when  it  may  arrive. 
So  that  joiiY partial  measures  for  "being  in  the  way"  your- 
self, only  increase  the  necessity  for  his  thought.  Whereas, 
if  you  could  but  arrange  that  the  thing  should  always  be 
done  whether  you  are  there  or  not,  he  need  never  think 
at  all  about  it. 

For  the  above  reasons,  whatever  a  patient  ca7i  do  for 

*  Why  should  you  let  yovir  patient  ever  be  surprised,  except  by 
thieves  ?  I  do  not  know.  In  England,  people  do  not  come  down  the 
chimney,  or  through  the  window,  unless  they  are  thieves.  They  come 
in  by  the  door,  and  somebody  must  open  the  door  to  them.  The 
"  somebody  "  charged  with  opening  the  door  is  one  of  two,  three,  or 
at  most  four  persons.  AVhy  cannot  these,  at  most,  four  persons  be 
put  in  charge  as  to  what  is  to  be  done  when  there  is  a  ring  at  the 
door-bell  ? 

The  sentry  at  a  post  is  changed  much  oftener  than  any  servant  at  a 
private  house  or  institution  can  possibly  be.  But  what  should  we 
think  of  such  an  excuse  as  this :  that  the  enemy  had  entered  such  a 
post  because  A  and  not  B  had  been  on  guard  ?  Yet  I  have  constantly 
heard  such  an  excuse  made  in  the  private  house  or  institution,  and 
accepted:  viz.,  that  such  a  person  had  been  "let  in"  or  7iot  "let  in," 
and  such  a  parcel  had  been  wrongly  delivered  or  lost  because  A  and 
not  B  had  opened  the  door  ! 

a* 


80  NOTES  OK  NURSING. 

tiraself,  it  is  better,  i.  e.,  less  anxiety,  for  him  to  do  for  him- 
self, unless  the  person  in  charge  has  the  spirit  of  manage- 
ment. 

It  is  evidently  much  less  exertion  for  a  patient  to  ans\ver 
a  letter  for  himself  by  return  of  post,  than  to  have  four 
conversations,  wait  five  days,  have  six  anxieties  before  it 
is  off  his  mind,  before  the  j^erson  who  has  to  answer  it  has 
done  so. 

Apprehension,  uncertainty,  waiting,  expectation,  fear  of 
surprise,  do  a  patient  more  harm  than  any  exertion.  Re- 
member, he  is  face  to  face  with  his  enemy  all  the  time, 
internally  wrestling  with  him,  having  long  imaginary  con- 
versations with  him.  You  are  thinkmg  of  something  else. 
"Rid  him  of  his  adversary  quickly,"  is  a  first  rule  with 
the  sick.* 

For  the  same  reasons,  always  tell  a  patient  and  tell  him 
beforehand  when  you  are  going  out  and  when  you  will  be 
back,  whether  it  is  for  a  day,  an  hour,  or  ten  minutes. 
You  fancy  perhaps  that  it  is  better  for  him  if  he  does  not 
find  out  your  going  at  all,  better  for  him  if  you  do  not 
make  yourself  "of  too  much  importance"  to  him;  or  else 
you  cannot  bear  to  give  him  the  pain  or  the  anxiety  of 
the  temporary  separation. 

No  such  thing.  You  ought  to  go  we  will  suppose.  Health 
or  duty  requires  it.  Then  say  so  to  the  patient  openly. 
If  you  go  without  his  knowing  it,  and  he  finds  it  out,  he 
never  will  feel  secure  again  that  the  things  which  depend 
upon  you  will  be  done  when  you  are  away,  and  in  nine 
cases  out  of  ten  he  will  be  right.  If  you  go  out  without 
telling  him  when  you  will  be  back,  he  can  take  no  meas- 
ures nor  precautions  as  to  the  things  which  concern  you 
both,  or  which  you  do  for  him. 

If  you  look  into  the  reports  of  trials  or  accidents,  and 
especially  of  suicides,  or  into  the  medical  history  of  fital 
cases,  it  is  ahnost  incredible  how  often  the  whole  thing 
turns  upon  something  which  has  happened  because  "he," 

*  There  are  man)-  physical  operations  where  cfcteris  paribus  the  dan- 
ger is  in  a  direct  ratio  to  the  time  the  operation  lasts  ;  and  ccefcris  pari' 
bics  the  operator's  success  will  be  in  direct  ratio  to  his  quickness.  Now 
there  are  many  mental  operations  where  exactly  the  same  rule  holds 
good  with  the  sick ;  c(vteris  paribus  their  capability  of  bearing  such 
operations  depends  directly  on  the  quickness,  xcithou't  hurry ^  with  wliich 
they  can  be  got  through. 


PETTY  MANAGEMENT.  31 

or  Still  oftener  "she,"  "was  not  tliere."  But  it  is  still  more 
incredible  how  often,  how  almost  always  tliis  is  accepted 
as  a  sufficient  reason,  a  justification  ;  why,  the  very  fact  of 
the  thing  having  happened  is  the  proof  of  its  not  being  a 
justification.  The  person  in  charge  was  quite  right  not  to 
be  "^Aere,"  he  was  called  away  for  quite  sufficient  reason,  or 
he  was  away  for  a  daily  recurring  and  unavoidable  cause ; 
yet  no  provision  was  made  to  supply  his  absence.  The 
fault  was  not  in  his  "  being  away,"  but  in  there  being  no 
management  to  supplement  his  "being  away."  AYhen  the 
sun  is  under  a  total  eclipse  or  during  his  nightly  absence, 
we  light  candles.  But  it  would  seem  as  if  it  did  not  occur 
to  us  that  we  must  also  supplement  the  person  in  charge 
of  sick  or  of  children,  whether  under  an  occasional  eclipse 
or  during  a  regular  absence. 

In  institutions  where  many  lives  would  be  lost  and  the 
effect  of  such  want  of  management  would  be  terrible  and 
patent,  there  is  less  of  it  than  in  the  private  house.* 

*  So  true  is  this  that  I  could  meution  two  eases  of  women  of  very 
high  position,  both  of  whom  died  in  the  same  way  of  the  consequences 
of  a  surgiciil  operation.  And  in  both  cases,  I  was  told  by  the  highest 
authority  that  the  fatal  result  would  not  have  happened  in  a  London 
hospital. 

But,  as  far  as  regards  the  art  of  petty  management  in  hospitals,  all 
the  military  hospitals  I  know  must  l^e  excluded.  Upon  my  own  expe- 
rience I  stand,  and  I  solemnly  declare  that  I  have  seen  or  known  of 
fatal  accidents,  such  as  suicides  in  ddiriiim  tremens^  bleedings  to  death, 
dying  patients  dragged  out  of  bed  by  drunken  Medical  Staff  Corps 
men,  and  many  other  things  less  patent  and  striking,  which  would  not 
have  happened  in  London  civil  hospitals  nursed  by  women.  The  med- 
ical officers  shoiild  be  absolved  from  all  blame  in  these  accidents. 
How  can  a  medical  officer  mount  guard  all  day  and  all  night  over  a 
patient  (say)  in  deHrium  tremens  f  The  fault  lies  in  there  being  no 
organized  system  of  attendance.  "Were  a  trustworthy  man  in  charge 
of  each  ward,  or  set  of  wards,  not  as  ofiice  clerk,  but  as  head  nurse, 
(and  head  nurse  the  best  hospital  sergeant,  or  ward  master,  is  not  now 
and  cannot  be,  from  default  of  the  proper  regulations,)  the  thing  would 
not,  in  all  probability,  have  happened.  But  were  a  trustworthy  %coman 
in  charge  of  the  ward,  or  set  of  wards,  the  thing  would  not,  in  all  cer- 
tainty, have  happened.  In  other  words,  it  does  not  happen  where  a 
trustworthy  woman  is  really  in  charge.  And,  in  these  remarks,  I  by 
no  means  refer  only  to  exceptional  times  of  great  emergency  in  war 
hospitals,  but  also,  and  quite  as  much,  to  the  ordinary  run  of  military 
hospitals  at  home,  in  time  of  peace  ;  or  to  a  time  in  war  when  our  army 
was  actually  more  healthy  than  at  home  in  peace,  and  the  pressure  on 
our  hospitals  consequently  much  less. 

It  is   often   said   that,  in  regimental  hospitals,  patients  ought  to 


82  NOTES   ON  NUKSINOf, 

But  In  both,  let  wlioerer  is  in  charge  keep  this  simple 
question  in  her  head  (not,  how  can  I  always  do  this  riglit 
thing  myself,  but)  how  can  I  provide  for  this  right  thing 
to  be  always  done? 

Then,  when  anything  wrong  has  actually  happened  in 
consequence  of  her  absence,  which  absence  r>'e  will  sup- 
pose to  haye  been  quite  right,  let  her  question  still  be  {7ioty 
how  can  I  provide  against  any  more  of  such  absences? 
which  is  neither  possible  nor  desirable,  but)  how  can  I 
provide  against  anything  wrong  arising  out  of  my  ab- 
sence? 

How  few  men,  or  even  women,  understand,,  either  in 
great  or  in  little  things,  what  it  is  the  "being  in  charge" — I 
mean  know  how  to  caiTy  out  a  "charge."  From  the  most 
colossal  calamities,  down  to  the  most  trifling  accidents, 
results  are  often  traced  (or  rather  7iot  traced)  to  such  want 
of  some  one  "in  charge"  or  of  his  knowing  how  to  be  "in 
charge."  A  short  time  ago  the  bursting  of  a  funnel-casing 
on  board  the  finest  and  strongest  ship  that  ever  was  built, 
on  her  trial  trip,  destroyed  several  lives  and  put  several 
hundreds  in  jeopardy  —  not  from  any  undetected  flaw  in 
her  new  and  untried  works — but  from  a  tap  being  closed 
which  ought  not  to  have  been  closed  —  from  wliat  every 
child  knows  would  make  its  mother's  tea-kettle  burst.   And 

♦•nurse  each  other,"  because  the  number  of  sick  altogether  beina:,  say, 
but  thirty,  and  out  of  these  one  only  perhaps  being  seriously  ill,  and 
the  other  twenty-nine  ha\-ing  little  the  matter  Avith  them,  and  nothing 
to  do,  they  should  be  set  to  nurse  the  one ;  also,  that  soldiers  are  so 
trained  to  obey,  that  they  will  be  the  most  obedient,  and  therefore  the 
best  of  nurses,  add  to  which  they  are  always  kind  to  their  comrades. 

Now,  have  those  who  say  this,  considered  that,  in  order  to  obey, 
you  must  know  how  to  obey,  and  that  these  soldiers  certainly  do  not 
know  how  to  obey  in  nm-sing.  I  have  seen  these  "kind  "  fellows  (and 
how  kind  they  are  no  one  knows  so  Avell  as  myself)  move  a  comrade 
so  that,  in  one  case  at  least,  the  man  died  in  the  act.  I  have  seen  the 
comrades'  "kindness"  produce  abundance  of  spirits,  to  be  drunk  in 
secret.  Let  no  one  understand  by  this  that  female  nurses  ought  to,  or 
cotdd  be  introduced  in  reghnental  hospitals.  It  would  be  most  unde- 
sirable, even  were  it  not  impossible.  But  the  head  nurseship  of  a  hos- 
pital sergeant  is  the  more  essential,  the  m.ore  important,  the  more 
inexperienced  the  nurses.  Undoubtedly,  a  London  hospital  "sister" 
does  sometimes  set  relays  of  patients  to  watch  a  critical  case ;  but, 
undoubtedly  also,  always  under  her  OAvn  superintendence  ;  and  she  is 
called  to  whenever  there  is  something  to  be  done,  and  she  knows  how 
to  do  it.  The  patients  are  not  left  to  do  it  of  their  own  unassisted 
tfcnius,  however  "kind"  and  willing  they  may  be. 


PETTY  MANAGEMENT.  S3 

this  simply  because  no  one  seemed  to  know  vrhat  it  is  to 
be  "in  cliai-ge,"  or  ichowas  in  clinrge.  Xav  more,  the  jury 
at  the  inquest  actually  altogether  ignored  the  same,  and 
apparently  considered  the  taj)  "in  charge,"  for  they  gave 
as  a  A^erdict  "  accidental  death." 

This  is  the  meaning  of  the  word,  on  a  large  scale.  On 
a  much  smaller  scale,  it  happened,  a  short  time  ago,  that 
an  insane  person  burned  herself  slowly  and  intentionally 
to  death,  while  in  her  doctor's  charge,  and  almost  in  her 
nurse's  presence.  Yet  neither  was  considered  "  at  all  to 
blame."  The  very  fact  of  the  accident  happening  proves 
its  own  case.  There  is  nothing  more  to  be  said.  Either 
they  did  not  know  their  business  or  they  did  not  know 
how  to  peiform  it. 

To  be  "in  charge"  is  certainly  not  only  to  caiTy  out  the 
proper  measures  yourself  but  to  see  that  every  one  else 
does  so  too ;  to  see  that  no  one  either  wilfully  or  igno- 
rantly  thwarts  or  prevents  such  measures.  It  is  neither  to^ 
do  everything  yourself  nor  to  appoint  a  number  of  people  to^ 
each  duty,  but  to  ensure  that  each  does  that  duty  to  which 
he  is  appointed.  This  is  the  meaning  which  must  be  at- 
tached to  the  word  by  (above  all)  those  "in  charge"  of 
sick,  whether  of  numbers  or  of  individuals,  (and  indeed  I 
think  it  is  with  individual  sick  that  it  is  least  understood. 
One  sick  person  is  often  waited  on  by  four  with  less  pre- 
cision, and  is  really  less  cared  for  than  ten  who  are  waited 
on  by  one ;  or  at  least  than  forty  who  are  waited  on  by 
four ;  and  all  for  want  of  this  one  person  "  in  charge.") 

It  is  often  said  that  there  are  few  good  servants  now ;  I 
say  there  are  few  good  mistresses  now.  As  the  jury  seems 
to  have  thought  the  tap  was  in  charge  of  the  shiji's  safety, 
so  mistresses  now  seem  to  think  the  house  is  in  charge  of 
itself  They  neither  know  how  to  give  orders,  nor  how  to 
teach  their  servants  to  obey  orders  —  i.  e.,  tb  obey  intelh- 
gently,  which  is  the  real  meaning  of  all  discipline. 

Again,  people  who  are  in  charge  often  seem  to  have  a 
pride  in  feeling  that  they  will  be  "missed,"  that  no  one 
can  understand  or  carry  on  their  arrangements,  their  system, 
books,  accounts,  &c.,  but  themselves.  It  seems  to  me  that 
the  pride  is  rather  in  carrying  on  a  sj'stem,  in  keeping 
stores,  closets,  books,  accounts,  &c.,  so  that  any  body  can 
Tuidcrstand  and  carry  them  on — so  that,  in  case  of  absence 
or  illness,  one  can  deliver  everything  up  to  others  and 


84  NOTES   ON  NURSING. 

know  that  all  will  go  on  as  usual,  and  that  one  shall  never 
be  missed. 

Note.  —  It  is  often  complained,  that  professional  nurses,  brought 
into  private  families,  in  case  of  sickness,  make  themselves  intolerable 
by  "ordering  about"  the  other  servants,  under  pka  of  not  neglecting 
the  patient.  Both  things  are  true  ;  the  patient  is  often  neglected,  and 
the  servants  are  often  unfairly  "put  upon."  But  the  fault  is  gen- 
erally in  the  want  of  management  of  the  head  in  charge.  It  is  surely 
for  her  to  arrange  both  that  the  nurse's  place  is,  when  necessary,  sup- 
plemented, and  that  the  patient  is  never  neglected  —  things  with  a  little 
management  quite  compatible,  and  indeed  only  attainable  together.  It 
is  certainly  not  for  the  nurse  to  "order  about"  the  servants. 


IV.    NOISE. 

Unnecessary  noise,  or  noise  that  creates  an  expectation 
in  the  mind,  is  that  which  hurts  a  patient.  It  is  rarely  the 
J.oudness  of  the  noise,  the  effect  upon  the  organ  of  the  ear 
Itself,  which  appears  to  affect  the  sick.  How  well  a  patient 
w^ill  generally  bear,  e.  g,,  the  putting  up  of  a  scaffolding 
close  to  the  house,  when  he  cannot  bear  the  talking,  still 
less  the  whispering,  especially  if  it  be  of  a  familiar  voice, 
outside  his  door. 

There  are  certain  patients,  no  doubt,  especially  where 
there  is  slight  concussion  or  other  disturbance  of  the  brain, 
who  are  affected  by  mere  noise.  But  intermittent  noise,  or 
sudden  and  sharp  noise,  in  these,  as  in  all  other  cases,  affects 
far  more  than  continuous  noise  —  noise  with  jar  far  more 
than  noise  without.  Of  one  thing  you  may  be  certain,  that 
anything  which  wakes  a  patient  suddenly  out  of  his  sleep 
will  invariably  put  him  into  a  state  of  greater  excitement, 
do  him  more  serious,  aye,  and  lasting  mischief,  than  any 
continuous  noise,  however  loud.  ,, 

Never  to  allow  a  patient  to  be  waked,  intentionally  or 
accidentally,  is  a  siiie  qua  non  of  all  good  nursing.  If  he 
is  roused  out  of  his  first  sleep,  he  is  almost  certain  to  have 
no  more  sleep.  It  is  a  curious  but  quite  intelligible  fact 
that,  if  a  patient  is  waked  after  a  few  hours'  instead  of  a 
few  minutes'  sleep,,  he  is  much  more  likely  to  sleep  again. 
Because  pain,  like  irritability  of  brain,  perpetuates  and  in- 
tensifies itself  If  you  have  gained  a  respite  of  either  in 
sleep  you  have  gained  more  than  the  mere  respite.  Both 
the  probability  of  recurrence  and  of  the  same  intensity 


NOISE.  35 

Will  be  dimmishecl ;  whereas  both  will  be  tembly  increased 
by  want  of  sleep.  This  is  the  reason  why  sleep  is  so  all- 
important.  This  is  the  reason  why  a  patient  waked  in  the 
early  part  of  his  sleep  loses  not  only  his  sleep,  but  his 
power  to  sleep.  A  healthy  person  who  allows  himself  to 
sleep  during  the  day  will  lose  his  sleep  at  night.  But  it  is 
exactly  the  reverse  with  the  sick  generally;  the  more  they 
sleep,  the  better  will  they  be  able  to  sleep. 

I  have  often  been  surprised  at  the  thoughtlessness,  (re- 
sulting in  cruelty,  quite  unintentionally)  of  friends  or  of 
doctors  who  will  hold  a  long  conversation  just  in  the  room 
or  passage  adjoining  to  the  room  of  the  patient,  who  is 
either  every  moment  expecting  them  to  come  in,  or  who 
has  just  seen  them,  and  knows  they  are  talking  about  him. 
If  he  is  an  amiable  patient,  he  will  try  to  occupy  his  atten- 
tion elsewhere  and  not  to  listen  —  and  this  makes  matters 
worse  —  for  the  strain  upon  his  attention  and  the  eifort  he 
makes  are  so  great  that  it  is  well  if  he  is  not  worse  for 
hours  after.  If  it  is  a  whispered  conversation  in  the  same 
room,  then  it  is  absolutely  cruel ;  for  it  is  impossible  that 
the  patient's  attention  should  not  be  involuntarily  strained 
to  hear.  Walking  on  tip-toe,  doing  anything  in  the  room 
very  slowly,  are  injurious,  for  exactly  the  same  reasons. 
A  firm,  light,  quick  step,  a  steady  quick  hand,  are  the  de- 
siderata ;  not  the  slow,  lingering,  shuffling  foot,  the  timid, 
uncertain  touch.  Slowness  is  not  gentleness,  though  it  is 
often  mistaken  for  such  :  quickness,  lightness,  and  gentle- 
ness are  quite  compatible.  Again,  if  friends  and  doctors 
did  but  watch,  as  nurses  can  and  should  watch,  the  features 
sharpening,  the  eyes  growing  almost  wild,  of  fever  patients 
who  are  listening  for  the  entrance  from  the  corridor  of  the 
persons  whose  voices  they  are  hearing  there,  these  would 
never  run  the  risk  again  of  creating  such  expectation,  or 
irritation  of  mind.  Such  unnecessary  noise  has  undoubt- 
edly induced  or  aggravated  delirium  in  many  cases.  I  have 
known  such-— in  one  case  death  ensued.  It  is  but  fair  to 
say  that  this  death  was  attributed  to  fright.  It  was  the 
result  of  a  long  whispered  conversation,  within  sight  of 
the  patient,  about  an  impending  operation ;  but  any  one 
who  has  known  the  more  than  stoicism,  the  cheerful  cool- 
ness, with  which  the  certainty  of  an  operation  will  be  ac- 
cepted by  any  patient,  capable  of  bearing  an  operation  at 
all,  if  it  is  properly  communicated  to  him,  will  hesitate  to 


86  NOTES   On   K1JR3ING. 

believe  that  it  was  mere  fear  which  produced,  as  was 
averred,  the  fiital  result  in  this  instance.  It  was  rather  the 
uncertainty,  the  strained  expectation  as  to  what  was  to  be 
decided  upon. 

I  need  hardly  say  that  the  other  common  cause,  namely, 
for  a  doctor  or  friend  to  leave  the  patient  and  communi- 
cate his  opinion  on  the  result  of  his  visit  to  the  friends  just 
outside  the  patient's  door,  or  in  the  adjoining  room,  after 
the  visit,  but  within  hearing  or  knowledge  of  the  jDatient 
is,  if  possible,  worst  of  all. 

It  is,  I  think,  alarming,  peculiarly  at  this  time,  wiien 
the  female  ink-bottles  are  perpetually  impressing  upon  us 
"woman's"  "particular  worth  and  general  missionariness," 
to  see  that  the  dress  of  women  is  daily  more  and  more  un- 
fitting them  for  any  "  mission,"  or  usefulness  at  all.  It  is 
equally  unfitted  for  all  poetic  and  all  domestic  purposes. 
A  man  is  now  a  more  handy  and  far  less  objectionable  be- 
ing in  a  sick  room  than  a  woman.  Compelled  by  her  dress, 
every  woman  now  either  shuffles  or  waddles  —  only  a  man 
can  cross  the  floor  of  a  sick-room  without  shaking  it !  What 
is  become  of  woman's  light  step  ?  —  the  firm,  light,  quick 
step  we  have  been  asking  for? 

Unnecessary  noise,  then,  is  the  most  cruel  absence  of 
care  which  can  be  inflicted  either  on  sick  or  well.  For,  in 
all  these  remarks,  the  sick  are  only  mentioned  as  suffering 
in  a  greater  proportion  than  the  well  from  precisely  the 
same  causes. 

Unnecessary  (although  slight)  noise  injures  a  sick  per- 
son much  more  than  necessary  noise  (of  a  much  greater 
amount.) 

All  doctrines  about  mysterious  affinities  and  aversions 
will  be  found  to  resolve  themselves  very  much,  if  not  en- 
tirely, into  presence  or  absence  of  care  in  these  things. 

A  nurse  w^ho  rustles  (I  am  speaking  of  nurses  jirofes- 
sional  and  unprofessional)  is  the  horror  of  a  patient,  though 
perhaps  he  does  not  know  why. 

The  fidget  of  silk  and  of  crinoline,  the  rattling  of  keys, 
the  creaking  of  stays  and  of  shoes,  will  do  a  patient  more 
harm  than  all  the  medicines  in  the  world  will  do  him 
good. 

The  noiseless  step  of  woman,  the  noiseless  drapery  of 
woman,  are  mere  figures  of  speech  in  this  day.  Her  skirts 
(and  well  if  they  do  not  throw  down  some  piece  of  furni- 


NOISE.  87 

ture)  will  at  least  brush  against  every  article  in  the  room 
as  she  moves.* 

Again,  one  nurse  cannot  open  the  door  without  making 
everything  rattle.  Or  she  opens  the  door  unnecessarily 
often,  for  want  of  remembering  all  the  articles  that  might 
be  brought  in  at  once. 

A  good  nurse  will  always  make  sure  that  no  door  or 
window  in  her  patient's  room  shall  rattle  or  creak ;  that 
no  blind  or  curtain  shall,  by  any  change  of  wind  through 
the  open  Avindow  be  made  to  flap  —  especially  will  she  be 
careful  of  all  this  before  she  leaves  her  patients  for  the 
night.  If  you  wait  till  your  patients  tell  you,  or  remind 
you  of  these  things,  where  is  the  use  of  their  having  a 
nurse  ?  There  are  more  shy  than  exacting  patients,  in  all 
classes ;  and  many  a  patient  passes  a  bad  night,  time  after 
time,  rather  than  remmd  his  nurse  every  night  of  all  the 
things  she  has  forgotten. 

If  there  are  blinds  to  your  windows,  always  take  care 
to  have  them  well  up,  when  they  are  not  being  used.  A 
httle  piece  slipping  down,  and  flapping  with  every  draught, 
will  distract  a  patient. 

All  hurry  or  bustle  is  peculiarly  painful  to  the  sick. 
And  when  a  patient  has  compulsory  occupations  to  engage 
him,  instead  of  having  simply  to  amuse  himself,  it  becomes 
doubly  injurious.  The  friend  who  remains  standing  and 
fidgetting  about  while  a  patient  is  talking  business  to  him, 
or  the  friend  who  sits  and  proses,  the  one  from  an  idea  of 
not  letting  the  patient  talk,  the  other  from  an  idea  of 
amusing  him, —  each  is  equally  inconsiderate.  Always  sit 
down  when  a  sick  person  is  talking  business  to  you,  show 
no  signs  of  hurry,  give  complete  attention  and  full  consid- 

*  Fortunate  it  is  if  her  skirts  do  not  catch  fire  —  and  if  the  nurse 
docs  not  give  herself  v\p  a  sacrifice  together  with  her  patient,  to  bo 
burnt  in  her  own  petticoats.  I  wish  tlie  llegistrar-General  would  tell 
us  the  exact  number  of  deaths  by  burning  occasioned  by  this  absurd 
and  hideous  custom.  But  if  people  will  be  stupid,  let  them  take 
measures  to  protect  themselves  from  their  own  stupidity  —  measures 
•which  every  chemist  knows,  such  as  putting  alum  into  starch,  which 
prevents  starched  articles  of  dress  from  blazing  up. 

I  wish,  too,  that  people  who  wear  crinoline  could  see  the  indecency 
of  their  own  dress  as  other  people  see  it.  A  respectable  elderly  woman 
stooping  forward,  invested  in  crinoline,  exposes  quite  as  much  of  her 
own  person  to  the  patient  lying  in  the  room  as  any  opera  dancer  does 
on  the  stage.     But  no  one  will  ever  tell  her  this  luipleasant  tiuth. 

4 


38  NOTES   ON   NURSING. 

eration  if  your  advice  is  wanted,  and  go  away  tlie  moment 
the  subject  is  ended. 

Always  sit  within  the  patient's  view,  so  that  when  you 
speak  to  him  he  has  not  painfully  to  turn  his  head  round  in 
order  to  look  at  you.  Every  body  invcluntarily  looks  at  the 
person  speaking.  If  you  make  this  act  a  wearisome  one  on 
the  part  of  the  patient  you  are  doing  him  harm.  So  also 
if  by  continuing  to  stand  you  make  him  continuously  raise 
his  eyes  to  see  you.  Be  as  motionless  as  possible,  and 
never  gesticulate  in  speaking  to  the  sick. 

Never  make  a  patient  repeat  a  message  or  request, 
especially  if  it  be  some  time  after.  Occupied  patients  are 
often  accused  of  doing  too  much  of  their  own  business. 
They  are  instinctively  right.  How  often  you  hear  the  per- 
son charged  with  the  request  of  giving  the  message  or 
writing  the  letter,  say  half  an  hour  afterwards  to  the  pa- 
tient, "Did  you  appoint  12  o'clock?"  or,  "What  did  you 
say  was  the  address  ?  "  or  ask  perhaps  some  much  more  agi- 
tating question  —  thus  causing  the  patient  the  effort  of 
memory,  or,  worse  still,  of  decision,  all  over  again.  It  is 
really  less  exertion  to  him  to  write  his  letters  himself. 
Tliis  is  the  almost  universal  experience  of  occupied  invalids. 

This  brings  us  to  another  caution.  Never  speak  to  an 
invalid  from  behind,  nor  from  the  door,  nor  from  any  dis- 
tance from  him,  nor  when  he  is  doing  anything. 

The  official  politeness  of  servants  in  these  things  is  so 
grateful  to  invalids,  that  many  prefer,  without  knowing 
why,  having  none  but  servants  about  them. 

These  things  are  not  fancy.  If  we  consider  that,  with 
sick  as  with  well,  every  thought  decomposes  some  nerv- 
ous matter,  —  that  decomposition  as  well  as  re-composition 
of  nervous  matter  is  always  going  on,  and  more  quickly 
with  the  sick  than  with  the  well,  —  that,  to  obtrude  abrupt- 
ly another  thought  upon  the  brain  while  it  is  in  the  act  of 
destroying  nervous  matter  by  thinking,  is  calling  upon  it 
to  make  a  new  exertion,  —  if  we  consider  these  things, 
which  are  facts,  not  fimcies,  we  shall  remember  that  we  are 
doing  positive  injury  by  interrupting,  by  "startling  a  fanci- 
ful "  person,  as  it  is  called.      Alas !  it  is  no  fancy. 

If  the  invalid  is  forced,  by  his  avocations,  to  continue 
occupations  requiring  much  thinking,  the  injury  is  doubly 
great.  In  feeding  a  patient  sufl'ering  under  delirium  or 
stui^or  you  may  suffocate  him,  by  giving  him  his  food  sud» 


NOISE.  39 

'denly,  but  if  you  rub  Lis  lips  gently  with  a  spoon  and  thus 
attract  his  attention,  he  will  swallow  the  food  unconscious- 
ly, but  with  perfect  safety.  Thus  it  is  with  the  brain.  If 
you  ofler  it  a  thought,  especially  one  requiring  a  decision, 
abruptly,  you  do  it  a  real  not  fanciful  injury.  Xever  speak 
to  a  sick  person  suddenly;  but,  at  the  same  time,  do  not 
keep  his  expectation  on  the  tip-toe. 

This  rule,  indeed,  applies  to  the  well  quite  as  much  as  to 
the  sick.  I  have  never  known  persons  who  exposed  them- 
selves for  years  to  constant  interruption  who  did  not  mud- 
dle away  their  intellects  by  it  at  last.  The  process  with 
them  may  be  accomplished  without  pain.  With  the  sick, 
pain  gives  warning  of  the  injury. 

Do  not  meet  or  overtake  a  patient  who  is  moving  about 
in  order  to  speak  to  him,  or  to  give  him  any  message  or  let- 
ter. You  might  just  as  well  give  him  a  box  on  the  ear. 
I  have  seen  a  patient  fall  flat  on  the  ground  "s\'ho  was  stand- 
ing when  his  nurse  came  into  the  room.  This  was  an  acci- 
dent which  might  have  happened  to  the  most  careful  nurse. 
But  the  other  is  done  with  intention.  A  patient  in  such  a 
state  is  not  going  to  the  East  Indies.  If  you  would  wait 
ten  seconds,  or  walk  ten  yards  further,  any  promenade  he 
could  make  would  be  over.  You  do  not  know  the  eflbrt  it 
is  to  a  patient  to  remain  standing  for  even  a  quarter  of  a 
minute  to  listen  to  you.  If  I  had  not  seen  the  thing  done 
by  the  kindest  nurses  and  friends,  I  should  have  thought 
this  caution  quite  superfluous.* 

Patients  are  often  accused  of  being  able  to  "  do  much 
more  when  nobody  is  by."  It  is  quite  true  that  they  can. 
Unless  nurses  can  be  brought  to  attend  to  considerations  of 
the  kind  of  which  we  have  given  here  but  a  few  specimens, 

*  It  is  absolutely  essential  that  a  nurse  should  lay  this  down  as  a 
positive  rule  to  herself,  never  to  speak  to  any  patient  who  is  standing 
or  moving,  as  long  as  she  exercises  so  little  observation  as  not  to  know 
when  a  patient  cannot  bear  it.  I  am  satisfied  that  many  of  the  acci- 
dents which  happen  from  feeble  patients  tumbling  down  stairs,  fainting 
after  getting  up,  &c.,  happen  solely  from  the  nurse  popping  out  of  a 
door  to  speak  to  the  patient  just  at  that  moment ;  or  from  his  fearing 
that  she  will  do  so  ;  and  that  i£  the  patient  were  even  left  to  himself 
till  he  can  sit  down,  such  accidents  would  much  seldomer  occur. 
If  the  nurse  accompanies  the  patient,  let  her  not  call  upon  him  to  speak. 
It  is  incredible  that  nurses  cannot  picture  to  themselves  the  strain 
upon  the  heart,  the  lungs,  and  the  brain,  Avhich  the  act  of  moving  is  to 
any  feeble  patient. 


40  'NOTES   ON   NURSING. 

a  very  weak  patient  finds  it  really  much  less  exertion  to  do 
tliino-s  for  himself  than  to  ask  for  tliem.  And  he  will,  in  or- 
der to  do  them,  (very  innocently  and  from  instinct)  calculate 
the  time  his  nurse  is  likely  to  be  absent  from  a  fear  of  her 
"coming  in  upon"  him  or  speaking  to  him, just  at  the  mo- 
ment when  he  finds  it  quite  as  much  as  he  can  do  to  crawl 
from  his  bed  to  his  chair,  or  from  one  room  to  another,  or 
down  stairs,  or  out  of  doors  for  a  few  minutes.  Some  ex- 
tra call  made  upon  his  attention  at  that  moment  will  quite 
upset  him.  In  these  cases  you  may  be  sure  that  a  patient 
in  the  state  we  have  described  does  not  make  such  exer- 
tions more  than  once  or  twice  a  day,  and  probably  much 
about  the  same  hour  every  day.  And  it  is  hard,  indeed,  if 
nurse  and  friends  cannot  calculate  so  as  to  let  him  make 
them  undisturbed.  Remember,  that  many  patients  can 
walk  who  cannot  stand  or  even  sit  up.  Standing  is,  of  all 
positions,  the  most  trying  to  a  weak  patient. 

Everything  you  do  in  a  jDatient's  room  after  he  is  "put 
up  "  for  the  night,  increases  tenfold  the  risk  of  his  having 
a  bad  night.  But,  if  you  rouse  him  up  after  he  has  fallen 
asleep,  you  do  not  risk,  you  secure  him  a  bad  night. 

One  hint  I  would  give  to  all  who  attend  or  visit  the  sick, 
to  all  who  have  to  pronounce  an  opinion  upon  sickness  or 
its  progress.  Come  back  and  look  at  your  patient  after  he 
has  had  an  hour's  animated  conversation  with  you.  It  is 
the  best  test  of  his  real  state  we  know.  But  never  pro- 
nounce upon  him  from  merely  seeing  what  he  does,  or  how 
he  looks,  during  such  a  conversation.  Learn  also  careful- 
ly and  exactly,  if  you  can,  how  he  passed  the  night  after  it. 

People  rarely,  if  ever,  feint  while  making  an  exertion. 
It  is  after  it  is  over.  Indeed,  almost  every  effect  of  over- 
exertion appears  after,  not  during  such  exertion.  It  is  the 
highest  folly  to  judge  of  the  sick,  as  is  so  often  done,  when 
you  see  them  merely  during  a  period  of  excitement.  Peo- 
ple have  very  often  died  of  that  which,  it  has  been  pro- 
claimed at  the  time,  has  "  done  them  no  harm."  * 

*  As  an  old  experienced  nurse,  I  do  most  earnestly  deprecate  all 
such  careless  words.  I  have  known  patients  delirious  all  night,  after 
seeing  a  visitor  who  called  thern  "better,"  thought  they  "  only  wanted 
a  little  amusement,"  and  who  came  again,  saying,- "I  hope  you  were 
not  the  worse  for  my  ^dsit,"  neither  waiting  for  an  answer,  nor  even 
looking  at  the  case.  No  real  patient  will  ever  say,  "Yes,  but  I  was  a 
great  deal  the  worse." 

It  is  not,  however,  either  death  or  delirium  of  which,  in  these  cases, 


NOISE.  41 

Remember  never  to  lean  against,  sit  upon,  or  nnneces- 
sarily  shake,  or  even  touch  the  bed  in  which  a  patient  lies. 
This  is  invariably  a  painful  annoyance.  If  you  shake  the 
chair  on  which  he  sits,  he  has  a  point  by  which  to  steady 
himself,  in  his  feet.  But  on  a  bed  or  sofa,  he  is  entirely 
at  your  mercy,  and  he  feels  every  jar  you  give  him  all 
through  him. 

In  all  that  we  have  said,  both  here  and  elsewhere,  let  it 
be  distinctly  understood  that  we  are  not  speaking  of  hypo- 
chondriacs. To  distinguish  between  real  and  fancied  dis- 
ease forms  an  important  branch  of  the  education  of  a 
nurse.  To  manage  flmcy  patients  forms  an  important 
branch  of  her  duties.  But  the  nursing  which  real  and  that 
which  fancied  patients  require  is  of  different,  or  rather  of 
opposite  character.  And  the  latter  will  not  be  spoken  of 
here.  Indeed,  many  of  the  symptoms  which  are  here 
mentioned  are  those  which  distinguish  real  from  fancied 
disease. 

It  is  true  that  hj^iochondriacs  very  often  do  that  behind 
a  nurse's  back  which  they  would  not  do  before  her  flice. 
Many  such  I  have  had  as  patients  who  scarcely  ate  any- 
thing at  their  regular  meals ;  but  if  you  concealed  food  for 
them  in  a  drawer,  they  would  take  it  at  night  or  in  secret. 
But  this  is  from  quite  a  difiei-ent  motive.  They  do  it  from 
the  wish  to  conceal.  Whereas  the  real  patient  will  often 
boast  to  his  nurse  or  doctor,  if  these  do  not  shake  their 
heads  at  him,  of  how  much  he  has  done,  or  eaten,  or  walked. 
To  return  to  real  disease. 

Conciseness  and  decision  are,  above  all  things,  neces- 
sary with  the  sick.  Let  your  thought  expressed  to  them 
be  concisely  and  decidedly  expressed.  What  doubt  and 
hesitation  there  may  be  in  your  own  mind  must  never  be 
communicated  to  theirs,  not  even  (I  would  rather  say  es- 
pecially not)  in  little  things.  Let  your  doubt  be  to  your- 
self, your  decision  to  them.  People  who  think  outside 
their  heads,  the  whole  process  of  whose  thought  appears, 
like  Homer's,  in  the  act  of  secretion,  who  tell  everything 

there  is  most  danger  to  the  patient.  ITnperceived  consequences  are 
far  more  likely  to  ensue.  You  will  have  impunity  —  the  poor  patient 
will  not.  That  is,  the  patient  will  suffer,  although  neither  he  nor  the 
inflictor  of  the  injury  will  attribute  it  to  its  real  cause.  It  will  not  be 
directly  traceable,  except  by  a  very  careful,  observant  nurse.  The  pa- 
tient will  often  not  even  mention  what  has  done  him  most  harm. 
4* 


42  NOTES   ON   NURSING. 

that  led  them  toward^  this  conchision  and  away  from  that, 
ouoht  never  to  be  with  the  siek. 

Irresohition  is  what  all  patients  most  dread.  Rather 
than  meet  this  in  others,  they  will  collect  all  their  data, 
and  make  up  their  minds  for  themselves.  A  change  of 
mind  in  others,  whether  it  is  regarding  an  operation,  or 
re-writing  a  letter,  always  injures  the  patient  more  than 
the  being  called  upon  to  make  up  his  mind  to  the  most 
dreaded  or  difficult  decision.  Farther  than  this,  in  very 
many  cases,  the  imagination  in  disease  is  far  more  active 
and  vivid  than  it  is  in  health.  If  you  propose  to  the  pa- 
tient change  of  air  to  one  place  one  hour,  and  to  another 
the  next,  he  has,  in  each  case,  immediately  constituted 
himself  in  imagination  the  tenant  of  the  place,  gone  over 
the  whole  premises  in  idea,  and  you  have  tired  him  as 
much  by  displacing  his  imagination,  as  if  you  had  actually 
carried  him  over  both  places. 

Above  all,  leave  the  sick  room  quickly  and  come  into  it 
quickly,  not  suddenly,  not  with  a  rush.  But  don't  let  the 
patient  be  wearily  waiting  for  when  you  will  be  out  of  the 
room  or  when  you  will  be  in  it.  Conciseness  and  decision 
in  your  movements,  as  well  as  your  words,  are  necessary 
in  the  sick  room,  as  necessary  as  absence  of  hurry  and 
bustle.  To  possess  yourself  entirely  will  ensure  you  from 
eitlier  failing  —  either  loitering  or  hurrying. 

If  a  patient  has  to  see,  not  only  to  his  own  but  also  to 
his  nurse's  punctuality,  or  perseverance,  or  readiness,  or 
calmness,  to  any  or  all  of  these  things,  he  is  far  better 
without  that  nurse  than  with  her  —  however  valuable  and 
handy  her  services  may  otherwise  be  to  him,  and  however 
incapable  he  may  be  of  rendering  them  to  himself 

With  regard  to  reading  aloud  in  the  sick  room,  my 
experience  is,  that  when  the  sick  are  too  ill  to  read  to 
themselves,  they  can  seldom  bear  to  be  read  to.  Children, 
eye-patients,  and  uneducated  persons  are  exceptions,  or 
where  there  is  any  mechanical  difficulty  in  reading.  People 
who  like  to  be  read  to,  have  generally  not  much  the  mat- 
ter with  them ;  while  in  fevers,  or  where  there  is  much 
irritability  of  brain,  the  effort  of  listening  to  reading  aloud 
has  often  brought  on  delirium.  I  speak  with  great  diffi- 
dence ;  because  there  is  an  almost  universal  impression 
that  it  is  sparing  the  sick  to  read  aloud  to  them.  But 
two  thin«'s  are  certain:  — 


NOISE.  43 

(1.)  If  tliere  is  some  matter  wliich  must  be  read  to  a 
sick  person,  do  it  slowly.  People  often  think  that  the  way 
to  get  it  over  with  least  fati.Gjue  to  him  is  to  get  it  over  in 
least  time.  They  gabble  ;  they  plunge  and  gallop  through 
the  reading.  There  never  was  a  greater  mistake.  Hou- 
din,  the  conjuror,  says  that  the  way  to  make  a  story  seem 
short  is  to  tell  it  slowly.  So  it  is  with  reading  to  the  sick, 
I  have  often  heard  a  patient  say  to  such  a  mistaken  reader, 
"Don't  read  it  to  me;  tell  it  me."*  Unconsciously  he  is 
aware  that  this  will  regulate  the  plunging,  the  reading 
with  unequal  paces,  slurring  over  one  part,  instead  of  leav- 
ing it  out  altogether,  if  it  is  unimportant,  and  mumbling 
an'other.  If  the  reader  lets  his  own  attention  wander,  and 
then  stops  to  read  up  to  himself,  or  finds  he  has  read  the 
wrong  bit,  then  it  is  all  over  with  the  poor  j^atient's  chance 
of  not  suffering.  Very  few  people  know  how  to  read  to 
the  sick ;  very  few  read  aloud  as  pleasantly  even  as  they 
speak.  In  reading  they  sing,  they  hesitate,  they  stammer, 
they  hurry,  they  mumble  ;  when  in  speaking  they  do  none 
of  these  things.  Reading  aloud  to  the  sick  ought  always 
to  be  rather  slow,  and  exceedingly  distinct,  but  not  mouth- 
ing —  rather  monotonous,  but  not  sing  song  —  rather  loud, 
but  not  noisy  — and,  above  all,  not  too  long.  Be  very 
sure  of  what  your  patient  can  bear. 

(2.)  The  extraordinary  habit  of  reading  to  oneself  in  a 
sick  room,  and  reading  aloud  to  the  patient  any  bits  which 
will  amuse  him  or  more  often  the  reader,  is  unaccountably 
thoughtless.  What  do  you  think  the  patient  is  thinking 
of  during  your  gaps  pf  non-reading  ?  Do  you  think  that 
he  amuses  himself  upon  what  you  have  read  for  precisely 
the  time  it  pleases  you  to  go  on  reading  to  yourself^  and 
that  his  attention  is  ready  for  something  else  at  precisely 
the  time  it  pleases  you  to  begin  reading  again  ?  Whether 
the  person  thus  read  to  be  sick  or  well,  whether  he  be 
doing  nothing  or  doing  something  else  while  being  thus 
read  to,  the  self-absorption  and  want  of  observation  of  the 
person  who  does  it,  is  equally  difficult  to  understand — ■ 
although  very  often  the  readet^  is  too  amiable  to  say  how 
much  it  hurts  him. 


*  Sick  children,  if  not  too  shy  to  speak,  will  always  express  this 
wish.  They  invariably  prefer  a  story  to  be  told  to  them  rather  than 
read  to  them. 


44  NOTES   ON   NURSING. 

One  thing  more:  —  From  the  flimsy  manner  in  which 
most  modern  houses  are  built,  where  every  step  on  the 
stairs,  and  along  the  floors,  is  felt  all  over  the  house ;  the 
higher  the  story,  the  greater  the  vibration.  It  is  incon- 
ceivable how  much  the  sick  suflTer  by  having  anybody 
overhead.  In  the  solidly  built  old  houses,  which  fortu- 
nately, most  hospitals  are,  the  noise  and  shaking  is  com- 
paratively trifling.  But  it  is  a  serious  cause  of  suftering, 
in  lightly  built  houses,  and  with  the  irritability  pecuhar  to 
some  diseases.  Better  for  put  such  patients  at  the  top  of 
the  house,  even  with  the  additional  fatigue  of  stairs,  if  you 
cannot  secure  the  room  above  them  being  untenanted; 
you  may  otherwise  bring  on  a  state  of  restlessness  which 
no  opium  will  subdue.  Do  not  neglect  the  warning,  when 
a  patient  tells  you  that  he  "feels  every  step  above  him 
to  cross  his  heart."  Remember  that  every  noise  a  patient 
cannot  see  partakes  of  the  character  of  suddenness  to  him ; 
and  I  am  persuaded  that  patients  with  these  peculiarly 
irritable  nerves,  are  positively  less  injured  by  having  per- 
sons in  the  same  room  with  them  than  overhead,  or  sep- 
arated by  only  a  thin  compartment.  Any  sacrifice  to 
secure  silence  for  these  cases  is  worth  while,  because  no 
air,  however  good,  no  attendance,  however  careful,  will  do 
anything  for  such  cases  without  quiet. 

Note.  —  The  effect  of  music  upon  the  sick  has  been  scarcely  at  all 
noticed.  In  fact,  its  expensiveness,  as  it  is  now,  makes  any  general 
application  of  it  quite  out  of  the  question.  I  will  only  remark  here, 
that  wind  instrimaents,  including  the  human  voice,  and  stringed  instru- 
ments capable  of  continuous  sound,  have  generally  a  beneficent  effect ; 
Avhile  the  piano-forte,  with  such  instruments  as  have  no  continuity  of 
sound,  has  just  the  reverse.  The  finest  piano-forte  playing  will  dam- 
age the  sick,  while  an  air,  like  "Home,  sweet  home,"  or  "  Assisa  a 
pie  d'un  salice,"  on  the  most  ordinary  grindmg  organ,  will  sensibly 
soothe  them  —  and  this  quite  independent  of  association. 


Y.     VARIETY. 

To  any  but  an  old  nurse,  or  an  old  patient,  the  degree 
would  be  quite  inconceivable  to  which  the  nerves  of  the 
sick  suffer  from  seeing  the  same  walls,  the  same  ceiling, 
the  same  surroundings  during  a  long  confinement  to  cne 
or  two  rooms. 


VARIETY.  45 

The  superior  cheerfulness  of  persons  suffering  severe 
paroxysms  of  pain  over  that  of  persons  suffering  from  ner- 
vous debiUty  has  often  been  remarked  upon,  and  attrib- 
uted to  the  enjoyment  of  the  former  of  their  intervals  of 
resj^ite.  I  incline  to  think  that  the  majority  of  cheerful 
cases  is  to  be  found  among  those  patients  who  are  not  con- 
fined to  one  room,  whatever  their  suffering,  and  that  tlie 
majority  of  depressed  cases  will  be  seen  among  those  sub- 
jected to  a  long  monotony  of  objects  about  them. 

The  nervous  frame  really  suffers  as  much  from  this  as 
the  digestive  organs  from  long  monotony  of  diet,  as,  e,  g.^ 
the  soldier  from  his  twenty-one  years'  "  boiled  beef." 

The  effect  in  sickness  of  beautiful  objects,  of  variety  of 
objects,  and  especially  of  brilliancy  of  color,  is  hardly  at 
all  appreciated. 

Such  cravings  are  usually  called  the  "fancies"  of  pa- 
tients. And  often  doubtless  patients  have  "fancies,"  as, 
e.  g.^  when  they  desire  two  contradictions.  But  much  more 
often,  their  (so  called)  "fancies"  are  the  most  valuable 
indications  of  what  is  necessary  for  their  recovery.  And 
it  would  be  well  if  nurses  would  watch  these  (so  called) 
"fancies"  closely. 

I  have  seen,  in  fevers,  (and  felt,  when  I  was  a  fever 
patient  myself,)  the  most  acute  suffering  produced  from 
the  patient  (in  a  hut)  not  being  able  to  see  out  of  window, 
and  the  knots  in  the  wood  being  the  only  view.  I  shall 
never  forget  the  rapture  of  fever  patients  over  a  bunch  of 
bright-colored  flowers.  I  remember  (in  my  own  case) 
a  nosegay  of  wild  flowers  being  sent  me,  and  from  that 
moment  recovery  becoming  more  rapid. 

People  say  the  effect  is  only  on  the  mind.  It  is  no  such 
thing.  The  effect  is  on  the  body,  too.  Little  as  we  know 
about  the  way  in  which  we  are  affected  by  form,  by  color, 
and  light,  we  do  know  this,  that  they  have  an  actual 
})hysical  effect. 

Variety  of  form  and  brilliancy  of  color  in  the  objects 
presented  to  patients  are  actual  means  of  recovery. 

But  it  must  be  sloio  variety,  e.  g.^  if  you  show  a  patient 
ten  or  twelve  engravings  successively,  ten-to-one  that  he 
does  not  become  cold  and  faint,  or  feverish,  or  even  sick ; 
but  hang  one  up  opposite  to  him,  on  each  successive  day, 
or  week,  or  month,  and  he  will  revel  in  the  variety. 

The  folly  and  ignorance  which  reign  too  often  supreme 


46  NOTES   ON   NURSING. 

over  the  sick-room,  cannot  be  better  exemplified  than  by 
uhis.  While  the  nurse  will  leave  the  patient  stewing  in  a 
corrupting  atmosphere,  the.  best  ingredient  of  which  is  car- 
bonic acid,  she  will  deny  him,  on  the  plea  of  unhealthiness, 
a  glass  of  cut-flowers,  or  a  gi'owing  plant.  Now,  no  one 
ever  saw  "overcrowding"  by  plants  in  a  room  or  ward. 
And  the  carbonic  acid  they  give  off  at  nights  would  not 
poison  a  fly.  Nay,  in  overcrowded  rooms,  they  actually 
absorb  carbonic  acid  and  give  off  oxygen.  Cut-flowers 
also  decompose  water  and  produce  oxygen  gas.  It  is  true 
there  are  certam  flowei-s,  e.  g.^  the  lilies,  the  smell  of  which 
is  said  to  depress  the  nervous  system.  These  are  easily 
known  by  the  smell,  and  can  be  avoided. 

Volumes  are  now  written  and  spoken  upon  the  effect  of 
the  mind  upon  the  body.  Much  of  it  is  true.  But  I  wish 
a  httle  more  was  thought  of  the  effect  of  the  body  on  the 
mind.  You  who  believe  yourselves  overwhelmed  with 
anxieties,  but  are  able  every  day  to  walk  up  Regent  Street, 
or  out  in  the  country,  to  take  your  meals  with  others  in 
other  rooms,  &c.,  &c.,  you  little  know  how  much  your  anx- 
ieties are  thereby  lightened ;  you  little  know  how  inten- 
sified they  become  to  those  who  can  have  no  change ;  * 
how  the  very  walls  of  their  sick  rooms  seem  hung  with 
their  cares ;  how  the  ghosts  of  their  troubles  haunt  their 
beds ;  how  impossible  it  is  for  them  to  escape  from  a  pur- 
suing thought  without  some  help  from  variety. 

A  patient  can  just  as  much  move  liis  leg  when  it  is  frac- 
tured as  change  his  thoughts  when  no  external  help  from 
variety  is  given  him.  This  is,  indeed,  one  of  the  main  suf- 
ferings of  Sickness;  just  as  the  fixed  posture  is  one  of  the 
main  sufferings  of  the  broken  limb. 

It  is  an  ever  recurring  wonder  to  see  educated  people, 

*  It  is  a  matter  of  painful  wonder  to  the  sick  themselves,  how  much 
painful  ideas  predominate  over  pleasurable  ones  in  their  impressions. 
They  reason  with  themselves  ;  they  think  themselves  ungrateful.  It 
is  all  of  no  use.  The  fact  is,  that  these  painful  impressions  are  for 
better  dismissed  by  a  real  laugh,  if  you  can  excite  one  by  books  or 
conversation,  than  by  any  direct  reasoning  ;  or  if  the  patient  is  too  weak 
to  laugh,  some  impression  from  nature  is  what  he  wants.  I  have 
mentioned  the  cruelty  of  letting  him  stare  at  a  dead  wall.  In  many  dis- 
eases, especially  in  convalescence  from  fever,  that  wall  will  appear  to 
make  all  sorts  of  faces  at  him  ;  now  flowers  never 'do  this.  Form, 
color,  wQl  free  your  patient  from  his  painful  ideas  better  than  any 
argument. 


VARIETY.  47 

who  call  themselves  nurses,  acting  thus.  They  vary  their 
own  objects,  their  own  employments,  many  times  a  day; 
and  while  nursing  (!)  some  bed-ridden  sufferer,  they  let  him 
lie  there  staring  at  a  dead  wall,  without  any  change  of  ob- 
ject to  enable  him  to  vary  his  thoughts ;  and  it  never  even 
occurs  to  them,  at  least  to  move  his  bed  so  that  he  can 
look  out  of  window.  No,  the  bed  is  to  be  always  left  in 
the  darkest,  dullest,  remotest  part  of  the  room.* 

I  think  it  is  a  very  common  error  among  the  well  to 
think  that,  "  with  a  little  more  self-control,"  the  sick  might, 
if  they  choose,  "  dismiss  painful  thoughts  "  which  "  aggra- 
vate their  disease,"  &c.  Believe  me,  almost  any  sick  per- 
son, who  behaves  decently  Avell,  exercises  more  self-control 
every  moment  of  his  day  than  you  will  ever  know  till  you 
are  sick  yourself.  Almost  every  step  that  crosses  his  room 
is  painful  to  him ;  almost  every  thought  that  crosses  his 
brain  is  painful  to  J^im :  and  if  he  can  speak  without  being 
savage,  and  look  without  being  unpleasant,  he  is  exercising 
self-controh 

Suppose  you  have  been  up  all  night,  and  instead  of  being 
allowed  to  have  your  cup  of  tea,  you  were  to  be  told  that 
you  ought  to  "  exercise  self-control,"  what  should  you  say  ? 
Now,  the  nerves  of  the  sick  are  always  in  the  state  that 
yours  are  in  after  you  have  been  up  all  night. 

We  Avill  suppose  the  diet  of  the  sick  to  be  cared  for. 
Then,  this  state  of  nerves  is  most  frequently  to  be  relieved 
by  care  in  affording  them  a  pleasant  view,  a  judicious  va- 


*  I  remember  a  case  in  point.  A  man  received  an  injury  to  the 
spine,  from  an  accident,  which,  after  a  long  confinement,  ended  in 
death.  He  was  a  workman  —  had  not  in  his  composition  a  single 
grain  of  what  is  called  "enthusiasm  for  nature"  — but  he  was  des- 
perate to  •'  see  once  more  ovit  of  window."  His  nurse  actually  got 
him  on  her  back,  and  managed  to  perch  him  up  at  the  window  for  an 
instant,  "  to  see  out."  The  consequence  to  the  poor  nurse  was  a  seri- 
ous illness,  which  nearly  proved  fatal.  The  man  never  knew  it ;  but 
a  great  many  other  people  did.  Yet  the  consequence  in  none  of  their 
minds,  so  far  as  I  know,  was  the  conviction  that  the  craving  for 
variety  in  the  starving  eye,  is  just  as  desperate  as  that  of  food  in  the 
starving  stomach,  and  tempts  the  famishing  creature  in  either  case  to 
steal  for  its  satisfaction.  No  other  Avord  will  express  it  but  "  despera- 
tion." And  it  sets  the  seal  of  ignorance  and  stupidity  just  as  much 
on  the  governors  and  attendants  of  the  sick  if  they  do  not  provide  the 
sick-bed  \A\X\  a  "  view"  of  some  kind,  as  if  they  did  not  provide  the 
hospital  with  a  Idtchcn. 


48  NOTES   ON   NURSING. 

riety  as  to  flowers,*  and  pretty  things.  Light  by  itself 
will  often  relieve  it.  The  craving  for  "  the  return  of  day," 
which  tlie  sick  so  constantly  evince,  is  generally  nothing 
but  the  desire  for  light,  the  remembrance  of  the  relief 
which  a  variety  of  objects  before  the  eye  affords  to  the 
harassed  sick  mind. 

Again,  every  man  and  every  woman  has  some  amount 
of  manual  emplopnent,  excepting  a  few  fine  ladies,  who 
do  not  even  dress  themselves,  and  who  are  virtually  in  the 
same  category,  as  to  nerves,  as  the  sick.  Now,  you  can 
have  no  idea  of  the  relief  which  manual  labor  is  to  you  — 
of  the  degree  to  which  the  deprivation  of  manual  employ- 
ment increases  the  peculiar  irritabiUty  from  which  many 
sick  suffer. 

A  little  needle-work,  a  little  writing,  a  little  cleaning, 
would  be  the  greatest  relief  the  sick  could  have,  if  they 
could  do  it ;  these  are  the  greatest  r^ief  to  you,  though 
you  do  not  know  it.  Reading,  though  it  is  often  the  only 
thing  the  sick  can  do,  is  not  this  relief  Bearing  this  in 
mind,  bearing  in  mind  that  you  have  all  these  varieties  of 
employment  which  the  sick  cannot  have,  bear  also  in  mind 
to  obtain  for  them  all  the  varieties  which  they  can  enjoy. 

I  need  hardly  say  that  I  am  well  aware  that  excess  in 
needle-work,  in  writing,  in  any  other  continuous  employ- 
ment, will  produce  the  same  irritability  that  defect  in  man- 
ual emj^loyment  (as  one  cause)  produces  in  the  sick. 


A^.     TAKING  FOOD. 

Every  careful  observer  of  the  sick  will  agree  in  this  that 
thousands  of  patients  are  annually  starved  in  the  midst  of 
jDlenty,  from  want  of  attention  to  the  ways  which  alone 
make  it  possible  for  them  to  take  food.  This  want  of  at- 
tention is  as  remarkable  in  those  who  urge  ujDon  the  sick 
to  do  what  is  quite  impossible  to  them,  as  in  the  sick 
themselves  who  will  not  rnako  the  effort  to  do  what  is  per- 
fectly possible  to  them. 

For  instance,  to  the  large  majority  of  very  weak  patients 

*  Xo  one  Avho  has  watched  the  sick  can  doubt  the  fact,  that  some 
feel  stimulus  from  looking  at  scarlet  flowers,  exhaustion  from  looking 
at  deep  blue,  &c. 


TAKING  FOOD.  49 

it  is  quite  impossible  to  take  any  solid  food  before  11  a.m., 
nor  then,  if  their  strength  is  still  further  exhausted  by  fast- 
ing till  that  hour.  For  weak  patients  have  generally  fe- 
verish nights  and,  in  the  morning,  dry  mouths;  and,  if 
they  could  eat  with  those  dry  mouths,  it  would  be  the 
worse  for  them.  A  spoonful  of  beef-tea,  of  arrowroot  and 
wine,  of  egg  flip,  every  hour,  will  give  them  the  requisite 
nourishment,  and  j^revent  them  from  being  too  much  ex- 
hausted to  take  at  a  later  hour  the  solid  food,  which  is 
necessary  for  their  recovery.  And  every  patient  who  can 
swallow  at  all  can  swallow  these  liquid  things,  if  he 
chooses.  But  how  often  do  we  hear  a  mutton-chop,  an 
egg,  a  bit  of  bacon,  ordered  to  a  patient  for  breakfast,  to 
whom  (as  a  moment's  consideration  would  show  us)  it 
must  be  quite  impossible  to  masticate  such  things  at  that 
hour. 

Again,  a  nurse  is  ordered  to  give  a  patient  a  tea-cup  full 
of  some  article  of  food  every  three  hours.  The  patient's 
stomach  rejects  it.  If  so,  try  a  table-spoon  full  every 
hour ;  if  this  will  not  do,  a  tea-spoon  full  every  quarter  of 
an  hour. 

I  am  bound  to  say,  that  I  think  more  patients  are  lost 
by  want  of  care  and  ingenuity  in  these  momentous  mi- 
nutiae in  private  nursing  than  in  public  hospitals.  And  1 
think  there  is  more  of  the  entente  cordiale  to  assist  one 
another's  hands  between  the  doctor  and  his  head  nurse  in 
the  latter  institutions,  than  between  the  doctor  and  the  jDa- 
tient's  friends  in  the  private  house. 

If  we  did  but  know  the  consequences  which  may  ensue, 
in  very  weak  patients,  from  ten  minutes'  fasting '  or  reple- 
tion (I  call  it  repletion  when  they  are  obliged  to  let  too 
small  an  interval  elapse  betAveen  taking  food  and  some 
other  exertion,  owing  to  the  nurse's  unpunctuality),  we 
should  be  more  careful  never  to  let  this  occur.  In  very 
weak  patients  there  is  often  a  nervous  difficulty  of  swal- 
lowing, which  is  so  much  increased  by  any  other  call  upon 
their  strength  that,  unless  they  have  their  food  punctually 
at  the  minute,  which  minute  again  must  be  arranged  so  as 
to  fall  in  with  no  other  minute's  occupation,  they  can  take 
nothing  till  the  next  respite  occurs  —  so  that  an  unpunctu- 
ality or  delay  of  ten  minutes  may  very  well  turn  out  to  be 
one  of  two  or  three  hours.    And  why  is  it  not  as  easy  to 


60  NOTES  ON  NURSING. 

be  punctual  to  a  minute  ?  Life  often  literally  hangs  upon 
these  minutes. 

In  acute  cases,  where  life  or  death  is  to  be  determined 
in  a  few  hours,  these  matters  are  very  generally  attended 
to,  especially  in  hospitals ;  and  the  number  of  cases  is 
large  where  the  patient  is,  as  it  were,  brought  back  to  life 
by  exceeding  care  on  the  part  of  the  doctor  or  nurse,  or 
both,  in  ordering  and  giving  nourishment  with  minute  se- 
lection and  punctuaUty. 

But  in  chronic  cases,  lasting  over  months  and  years, 
where  the  fatal  issue  is  often  determined  at  last  by  mere 
protracted  starvation,  I  had  rather  not  enumerate  the  in- 
stances which  I  have  known  where  a  little  ingenuity,  and 
a  great  deal  of  perseverance,  might,  in  all  probability,  have 
averted  the  result.  The  consulting  the  hours  when  the 
l^atient  can  take  food,  the  observation  of  the  times,  often 
varying,  when  he  is  most  faint,  the  altering  seasons  of 
taking  food,  in  order  to  anticipate  and  prevent  such  times 
—  all  this,  which  requires  observation,  ingenuity,  and  per- 
severance (and  these  really  constitute  the  good  nurse), 
might  save  more  lives  than  we  wot  of. 

To  leave  the  patient's  untasted  food  by  his  side,  from 
meal  to  meal,  in  hopes  that  he  will  eat  it  in  the  interval  is 
simply  to  prevent  him  from  taking  any  food  at  all.  I  have 
known  patients  literally  incapacitated  from  taking  one 
article  of  food  after  another,  by  this  piece  of  ignorance. 
Let  the  food  come  at  the  right  time,  and  be  taken  away, 
eaten  or  uneaten,  at  the  right  time  ;  but  never  let  a  patient 
have  "  something  always  standing "  by  him,  if  you  don't 
wish  to  disgust  him  of  every  thing. 

On  the  other  hand,  I  have  known  a  patient's  life  saved 
(he  was  sinking  for  want  of  food)  by  the  simple  question, 
put  to  him  by  the  doctor,  "  But  is  there  no  hour  when  you 
feel  you  could  eat  ?  "  "  O,  yes,"  he  said,  "  I  could  always 
take  something  at  —  o'clock  and  —  o'clock."  The  thing 
was  tried  and  succeeded.  Patients  very  seldom,  however, 
can  tell  this ;  it  is  for  you  to  watch  and  find  it  out. 

A  patient  should,  if  possible,  not  see  or  smell  either  the 
food  of  others,  or  a  greater  amount  of  food  than  he  him- 
self can  consume  at  one  time,  or  even  hear  food  talked 
about  or  see  it  in  the  raw  state.  I  know  of  no  exception 
to  the  above  rule.  The  breaking  of  it  always  induces  a 
greater  or  less  incapacity  of  taking  food. 


TAKING   FOOD.  51 

In  hospital  wards  it  is  of  course  impossible  to  observe 
all  this ;  and  in  single  wards,  where  a  patient  must  be  con- 
tinuously and  closely  watched,  it  is  frequently  impossible 
to  relieve  the  attendant,  so  that  his  or  her  own  meals  can 
be  taken  out  of  the  ward.  But  it  is  not  the  less  true  that, 
in  such  cases,  even  where  the  patient  is  not  himself  aware 
of  it,  his  possibility  of  taking  food  is  limited  by  seeing  the 
attendant  eating  meals  under  his  observation.  In  some 
cases  the  sick  are  aware  of  it,  and  complain.  A  case 
where  the  patient  was  supposed  to  be  insensible,  but  com- 
plained as  soon  as  able  to  speak,  is  now  present  to  my 
recollection. 

Remember,  however,  that  the  extreme  punctuality  in 
well-ordered  hospitals,  the  rule  that  nothing  shall  be  done 
in  the  ward  while  the  patients  are  having  their  meals,  go 
f:ir  to  counterbalance  what  unavoidable  evil  there  is  in 
having  patients  together.  I  have  often  seen  the  private 
nurse  go  on  dusting  or  fidgeting  about  in  a  sick  room  all 
the  while  the  patient  is  eating,  or  trying  to  eat. 

That  the  more  alone  an  invalid  can  be  when  taking 
food,  the  better,  is  unquestionable ;  and,  even  if  he  must 
be  fed,  the  nurse  should  not  allow  him  to  talk,  or  talk  to 
him,  especially  about  food,  while  eating. 

When  a  person  is  compelled,  by  the  pressure  of  occupa- 
tion, to  continue  his  business  while  sick,  it  ought  to  be  a 
rule  WITHOUT  axy  exceptiox  whateveb,  that  no  one 
shall  bring  business  to  him  or  talk  to  him  while  he  is 
taking  food,  nor  go  on  talking  to  him  on  interesting  sub- 
jects up  to  the  last  moment  before  his  meals,  nor  make  an 
engagement  with  him  in\mediately  after,  so  that  there  be 
any  hurry  of  mind  while  taking  them. 

Upon  the  observance  of  these  rules,  especially  the  first, 
often  depends  the  patient's  capability  of  taking  food  at  all, 
or,  if  he  is  amiable  and  forces  himself  to  take  food,  of  de- 
riving any  nourishment  from  it. 

A  nurse  should  never  put  before  a  patient  milk  that  is 
sour,  meat  or  soup  that  is  turned,  an  egg  that  is  bad,  or 
vegetables  underdone.  Yet  often  I  have  seen  these  things 
brought  in  to  the  sick  in  a  state  perfectly  perceptible  to 
every  nose  or  eye  except  the  nurse's.  It  is  here  that  the 
clever  nurse  appears ;  she  will  not  bring  in  the  peccant 
article,  but,  not  to  disappoint  the  patient,  she  will  whip  up 
somcthincj  else  in  a  few  minutes.     Remember  that  sick 


52  NOTES   ON   NURSING. 

cookery  should  half  do  the  work  of  your  poor  patient's 
weak  digestion.  But  if  you  further  impair  it  with  your 
bad  articles,  I  know  not  what  is  to  become  of  him  or 
of  it. 

If  the  nurse  is  an  intelligent  being,  and  not  a  mere  car- 
rier of  diets  to  and  from  the  patient,  let  her  exercise  her 
intelligence  in  these  things.  How  often  we  have  known 
a  patient  eat  nothing  at  all  in  the  day,  because  one  meal 
was  left  untasted  (at  that  time  he  was  incapable  of  eating), 
at  another  the  milk  was  sour,  the  third  was  spoiled  by 
some  other  accident.  And  it  never  occurred  to  the  nurse 
to  extemporize  some  expedient,  —  it  never  occurred  to  her 
that  as  he  had  had  no  solid  food  that  day  he  might  eat  a 
bit  of  toast  (say)  with  his  tea  in  the  evening,  or  he  might 
have  some  meal  an  hour  earlier.  A  patient  who  cannot 
touch  his  dinner  at  two,  will  often  accept  it  gladly,  if 
brought  to  him  at  seven.  But  somehow  nurses  never 
"  think  of  these  things."  One  would  imagine  they  did 
not  consider  themselves  bound  to  exercise  their  judgment ; 
they  leave  it  to  the  patient.  Now  I  am  quite  sure  that  it 
is  better  for  a  patient  rather  to  suffer  these  neglects  than 
to  try  to  teach  his  nurse  to  nurse  him,  if  she  does  not 
know  how.  It  ruffles  him,  and  if  he  is  ill  he  is  in  no  condi- 
tion to  teach,  especially  upon  himself.  The  above  remarks 
apply  much  more  to  private  nursing  than  to  hospitals. 

I  would  say  to  the  nurse,  have  a  rule  of  thought  about 
your  patient's  diet;  consider,  remember  how  much  he  has 
had,  and  how  much  he  ought  to  have  to-day.  Generally, 
the  only  rule  of  the  private  patient's  diet  is  what  the  nurse 
has  to  give.  It  is  true  she  cannot  give  him  what  she  has 
not  got ;  but  his  stomach  does  not  wait  for  her  conven- 
ience, or  even  her  necessity.*  If  it  is  used  to  having  its 
stimulus  at  one  hour  to-day,  and  to-morrow  it  does  not 
have  it,  because  she  has  filled  in  getting  it,  he  will  suffer. 

*  'Why,  because  the  nurse  has  not  got  some  food  to-day  which  the  pa- 
tient takes,  can  the  patient  wait  four  hours  for  food  to-day,  who  could 
not  wait  t\A-o  hours  yesterday  ?  Yet  this  is  the  only  logic  one  generally 
hears.  On  the  other  hand,  the  other  logic,  viz.,  of  the  nurse  giving  a 
patient  a  thing  because  she  /las  got  it,  is  equally  ftital.  K  she  happens 
to  have  fresh  jelly  or  fresh  fruit,  she  will  frequently  give  it  to  the 
patient  half  an  hour  after  his  dinner,  or  at  his  dinner,"  when  he  cannot 
possibly  eat  that  and  the  broth  too  —  or  worse  still,  leave  it  by  his  bed- 
side till  he  is  so  sickened  with  the  sight  of  it  that  he  cannot  eat  it 
at  all. 


WHAT  POOD?  68 

She  must  be  always  exercising  her  ingenuity  to  supj^ly  de- 
fects, and  to  remedy  accidents  which  will  happen  among 
the  best  contrivers,  but  from  which  the  patient  does  not 
suffer  the  less,  because  "  they  cannot  be  helped." 

One  very  minute  caution,  -—  take  care  not  to  spill  into 
your  patient's  saucer,  in  other  words,  take  care  that  the 
outside  bottom  rim  of  his  cup  shall  be  quite  dry  and  clean; 
if,  every  time  he  lifts  his  cup  to  his  lips,  he  has  to  carry 
the  saucer  with  it,  or  else  -to  drop  the  liquid  upon,  and  to 
soil  his  sheet,  or  his  bed-gown,  or  pillow,  or  if  he  is  sitting 
up,  his  dress,  you  have  no  idea  what  a  difference  this 
minute  want  of  care  on  your  part  makes  to  his  comfort 
and  even  to  his  willincrness  for  food. 


Vn.    WHAT  FOOD? 

I  will  mention  one  or  two  of  the  most  common  errors 
among  women  in  charge  of  sick  respecting  sick  diet.  One 
is  the  belief  that  beef  tea  is  the  most  nutritive  of  all  arti- 
cles. Now,  just  try  and  boil  dov^n  a  lb.  of  beef  into  beef 
tea,  evaporate  your  beef  tea,  and  see  what  is  left  of  your 
beef  You  will  find  that  there  is  barely  a  teaspoonful  of 
sohd  nourishment  to  half  a  pint  of  water  in  beef  tea ;  — 
nevertheless  there  is  a  certain  reparative  quality  in  it,  we 
do  not  know  what,  as  there  is  in  tea;  —  but  it  may  safely 
be  given  in  almost  any  inflammatory  disease,  and  is  as  little 
to  be  depended  upon  with  the  healthy  or  convalescent 
where  much  nourishment  is  required.  Again,  it  is  an  ever 
ready  saw  that  an  egg  is  equivalent  to  a  lb.  of  meat,  — - 
whereas  it  is  not  at  all  so.  Also,  it  is  seldom  noticed  with 
how  many  patients,  particularly  of  nervous  or  bilious  tem- 
perament, eggs  disagree.  All  puddings  made  with  eggs, 
are  distasteftil  to  them  in  consequence.  An  egg  whipped 
up  with  wine,  is  often  the  only  form  in  which  they  can 
take  this  kind  of  nourishment.  Again,  if  the  patient  has 
attained  to  eating  meat,  it  is  sup])osed  that  to  give  liim 
meat  is  the  only  thing  needful  for  his  recovery ;  whereas 
scorbutic  sores  have  been  actually  known  to  appear  among 
sick  persons  living  in  the  midst  of  plenty  in  England, 
which  could  be  traced  to  no  other  source  than  this,  viz. : 
that  the  nurse,  depending  on  meat  alone,  had  allowed  the 
patient  to  be  without  vegetables  for  a  considerable  time, 
5* 


54  NOTKS  ON   NURSING. 

these  Ipittcr  being  so  badly  cooked  that  he  always  left 
them  untouched.  Arrovrroot  is  another  grand  depend- 
ence of  the  nurse.  As  a  vehicle  for  wine^  and  as  a  restor- 
ative quickly  prepared,  it  is  all  very  well.  But  it  is  noth- 
ing but  starch  and  water.  Flour  is  both  more  nutritive, 
and  less  liable  to  ferment,  and  is  preferable  wherever  it 
can  be  used. 

Again,  milk  and  the  preparations  from  milk,  are  a  most 
important  article  of  food  for  theisick.  Butter  is  the  liglit- 
est  kind  of  animal  fat,  and  though  it  wants  the  sugar  and 
some  of  the  other  elements  which  there  are  in  milk,  yet  it 
is  most  valuable  both  in  itself  and  in  enabling  the  patient 
to  eat  more  bread.  Flour,  oats,  groats,  barley,  and  their 
kind,  are,  as  we  have  already  said,  preferable  in  all  their 
preparations  to  all  the  preparations  of  arrowroot,  sago, 
tapioca,  and  their  kind.  Cream,  in  many  long  chronic 
diseases,  is  quite  irreplaceable  by  any  other  article  what- 
ever. It  seems  to  act  in  the  same  manner  as  beef  tea,  and 
to  most  it  is  much  easier  of  digestion  than  milk.  In  fact,  it 
seldom  disagrees.  Cheese  is  not  usually  digestible  by  the 
sick,  but  it  is  pure  nourishment  for  repairing  waste ;  and  I 
have  seen  sick,  and  not  a  few  either,  whose  craving  for 
cheese  shewed  how  much  it  was  needed  by  them.* 

But,  if  fresh  milk  is  so  valuable  a  food  for  the  sick,  the 
least  change  or  sourness  in  it,  makes  it  of  all  articles,  per- 
haps, the  most  injurious ;  diarrhcsa  is  a  common  result  of 
fresh  milk  allowed  to  become  at  all  sour.  The  nurse  there- 
fore ought  to  exercise  her  utmost  care  in  this.  In  larsje 
institutions  for  the  sick,  even  the  poorest,  the  utmost  care 
is  exercised.  Wenham  Lake  ice  is  used  for  this  express 
purpose  every  summer,  while  the  private  patient,  perhaps, 
never  tastes  a  drop  of  milk  that  is  not  sour,  all  through 
the  hot  weather,  so  little  does  the  private  nurse  understand 

*  In  the  diseases  produced  by  bad  food,  such  as  scorbutic  dysentery 
and  diarrhoea,  the  patient's  stomach  often  craves  for  and  digests  things, 
some  of  which  certainly  would  be  laid  down  in  no  dietary  that  ever 
was  invented  for  sick,  and  especially  not  for  such  sick.  The-e  are 
fruit,  pickles,  jams,  gingerbread,  fat  of  ham  or  bacon,  suet,  cheese,  but- 
ter, milk.  These  cases  I  have  seen  not  by  ones,  nor  by  tens,  but  by 
hundreds.  And  the  patient's  stomach  was  right  and  the  book  v/as 
wrong.  The  articles  craved  for,  in  these  cases,  might  have  l:)een  princi- 
pally arranged  under  the  two  heads  of  fat  and  vegetable  acids. 

There  is  often  a  marked  difference  between  men  and  women  in  thia 
matter  of  sick  feeding.     Women' .s  digestion  is  generally  slower. 


WHAT  FOOD  ?  65 

the  necessity  of  such  care.  Yet,  if  you  consider  that  the 
only  drop  of  real  nourishment  in  your  ]xatient's  tea  is  the 
drop  of  milk,  and  how  much  almost  all  English  patients 
depend  upon  their  tea,  you  will  see  the  great  importance 
of  not  depriving  your  patient  of  this  drop  of  milk.  But- 
termilk, a  totally  different  thing,  is  often  very  useful, 
especially  in  fevers. 

In  laying  down  rules  of  diet,  by  the  amounts  of  "  solid 
nutriment"  in  different  kinds  of  food,  it  is  constantly  lost 
sight  of  what  the  patient  requires  to  repair  his  v/aste,  what 
he  can  take  and  what  he  can't.  You  cannot  diet  a  patient 
from  a  book,  you  cannot  make  up  the  human  body  as  you 
would  make  up  a  prescription,  —  so  many  parts  "  carbonif- 
erous," so  many  parts  "  nitrogenous  "  will  constitute  a  per- 
fect diet  for  the  patient.  The  nui-se's  observation  here 
will  materially  assist  the  doctor  —  the  patient's  "fancies" 
will  materially  assist  the  nurse.  For  instance,  sugar  is  one 
of  the  most  nutritive  of  all  articles,  being  pure  carbon, 
and  is  particularly  recommended  in  some  books.  But  the 
vast  majority  of  all  patients  in  England,  young^  and  old, 
male  and  female,  rich  and  poor,  hospital  and  private,  dis- 
like sweet  things,  —  and  while  I  have  never  known  a  per- 
son take  to  sweets  when  he  was  ill  who  disliked  them 
when  he  was  well,  I  have  known  many  fond  of  them  when 
in  health,  who  in  sickness  would  leave  off  any  thing  sweet, 
even  to  sugar  in  tea,  —  sweet  puddings,  sweet  drinks,  are 
their  aversion ;  the  furred  tongue  almost  always  likes  what 
is  sharp  or  pungent.  Scorbutic  patients  are  an  exception, 
they  often  crave  for  sweetmeats  and  jams. 

Jelly  is  another  article  of  diet  in  great  favor  with  nurses 
and  friends  of  the  sick ;  even  if  it  could  be  eaten  solid,  it 
would  not  nourish,  but  it  is  simply  the  height  of  folly  to 
take  I  oz.  of  gelatine  and  make  it  into  a  certain  bulk  by 
dissolving  it  in  water  and  then  to  give  it  to  the  sick,  as  if 
the  mere  bulk  represented  nourishment.  It  is  now  known 
that  jelly  does  not  nourish,  that  it  has  a  tendency  to  pro- 
duce diarrhoea,  —  and  to  trust  to  it  to  repair  the  waste  of 
a  diseased  constitution  is  simply  to  starve  the  sick  under 
the  guise  of  feeding  them.  If  100  spoonfuls  of  jelly  were 
given  in  the  course  of  the  day,  you  Avould  have  given  one 
spoonful  of  gelatine,  which  spoonful  has  no  nutritive  power 
whatever. 

And,  nevertheless,  gelatine  contains  a  large  quantity  of 


66  NOTES  ON  NtTRglNG, 

nitrogen,  which  is  one  of  the  most  poweiful  elements  in 
nutrition ;  on  the  other  hand,  beef  tea  may  be  chosen  as 
an  ilhistration  of  great  nutrient  power  in  sickness,  co- 
existing with  a  very  small  amount  of  solid  nitrogenous 
matter. 

Dr.  Christison  says  that  "erery  one  will  be  struck  with 
the  readiness  with  which  "  certain  classes  of  "  patients  will 
often  take  diluted  meat  juice  or  beef  tea  repeatedly,  when 
they  refuse  all  other  kinds  of  food/'  This  is  particularly 
remarkable  in  "  cases  of  gastric  fever,  in  which,^'  he  says, 
"little  or  nothing  else  besides  beef  tea  or  diluted  meat 
juice  "  has  been  taken  for  weeks  or  even  months,  "  and  yet 
a  pint  of  beef  tea  contains  scarcely  ^  oz.  of  anything  but 
water,"  —  the  result  is  so  striking  that  he  asks  what  is  its 
mode  of  action?  "Not  simply  nutrient  —  ^  oz.  of  the 
most  nutritive  material  cannot  nearly  replace  the  daily 
wear  and  tear  of  the  tissues  in  any  circumstances.  Pos- 
sibly," he  saySj  "it  belongs  to  a  new  denomination  of 
remedies." 

It  has  been  obseiwed  that  a  small  quantity  of  beef  tea 
added  to  other  articles  of  nutrition  augments  their  power 
out  of  all  proportion  to  the  additional  amount  of  solid 
matter. 

The  reason  why  jelly  should  be  innutritions  and  beef  tea 
nutritious  to  the  sick,  is  a  secret  yet  undiscovered,  but  it 
clearly  shows  that  careful  observation  of  the  sick  is  the  only 
clue  to  the  best  dietary. 

Chemistry  has  as  yet  afforded  little  insight  into  the 
dieting  of  sick.  All  that  chemistry  can  tell  us  is  the 
amount  of  "  carboniferous  "  or  "  nitrogenous  "  elements  dis- 
coverable in  different  dietetic  articles.  It  hns  given  us 
lists  of  dietetic  substances,  arranged  in  the  order  of  their 
richness  in  one  or  other  of  these  principles;  but  that  is  all. 
In  the  great  majority  of  cases,  the  stomach  of  the  patient 
is  guided  by  other  principles  of  selection  than  merely  the 
amount  of  carbon  or  nitrogen  in  the  diet.  Xo  doubt,  in 
this  as  in  other  things,  nature  has  very  definite  niles  for 
her  guidance,  but  these  rules  can  onl}'^  be  ascertained  by 
the  most  careful  observation  at  the  bed-side.  She  there 
teaches  us  that  living  chemistry,  the  chemistry  of  repara- 
tion, is  something  different  from  tlie  chemistry  of  the  labo- 
ratory. Organic  cliemistry  is  useful,  as  all  knowledge  is, 
when  we  come  face  to  face  with  nature ;   but  it  by  no 


WHAT   FOOD  ?  57 

means  follows  that  we  shoiild  learn  in  the  laboratory  any 
one  of  the  reparative  processes  going  on  in  disease. 

Again,  the  nutritive  power  of  milk  and  of  the  prepara- 
tions from  milk,  is  very  much  undervalued  ;  there  is  nearly 
as  much  nourishment  in  half  a  pint  of  milk  as  there  is  in  a 
quarter  of  a  lb.  of  meat.  But  this  is  not  the  whole  ques- 
tion or  nearly  the  whole.  The  main  question  is  what  the 
patient's  stomach  can  assimilate  or  derive  nourishment 
from,  and  of  this  the  patient's  stomach  is  the  sole  judge. 
Chemistry  cannot  tell  this.  The  patient's  stomach  must 
be  its  own  chemist.  The  diet  which  will  keep  the  healthy 
man  healthy,  will  kill  the  sick  one.  The  same  beef  which 
is  the  most  nutritive  of  all  meat  which  nourishes  the 
healthy  man,  is  the  least  nouiishing  of  all  food  to  the  sick 
man,  whose  half-dead  stomach  can  assimilate  no  part  of  it, 
that  is,  make  no  food  out  of  it.  On  a  diet  of  beef  tea 
healthy  men  on  the  other  hand  speedily  lose  their  strength. 

I  have  known  patients  live  for  many  months  without 
touching  bread,  because  they  could  not  eat  baker's  bread. 
These  were  mostly  country  patients,  but  not  all.  Home- 
made bread  or  brown  bread  is  a  most  important  article  of 
diet  for  many  patients.  The  use  of  aperients  may  be 
entirely  superseded  by  it.     Oat  cake  is  another. 

To  watch  for  the  opinions,  then,  which  the  patient's 
stomach  gives,  rather  than  to  read  "  analyses  of  foods,"  is 
the  business  of  all  those  who  have  to  settle  what  the  patient 
is  to  eat  —  perhaps  the  most  important  thing  to  be  2)ro- 
vided  for  him  after  the  air  he  is  to  breathe. 

Now  the  medical  man  who  sees  the  patient  only  once  a 
day  or  even  only  once  or  twice  a  week,  cannot  possibly  tell 
this  without  the  assistance  of  the  patient  himself,  or  of 
those  who  are  in  constant  obser\"ation  on  the  patient.  The 
utmost  the  medical  man  can  tell  is  whether  the  patient  is 
weaker  or  stronger  at  this  visit  than  he  was  at  the  last  visit. 
I  should  therefore  say,  that  incomparably  the  most  impor- 
tant office  of  the  nurse,  after  she  has  taken  care  of  the 
patient's  air,  is  to  take  care  to  observe  the  effect  of  his  food, 
and  report  it  to  the  medical  attendant. 

It  is  quite  incalculable  the  good  that  would  certainly 
come  from  such  sound  and  close  observation  in  this  almost 
neglected  branch  of  nursing,  or  the  help  it  would  give  to 
tlie  medical  man. 


68  NOTES   ON   NURSING. 

A  great  deal  too  much  against  tea*  is  said  by  wise  peo- 
ple, and  a  great  deal  too  much  of  tea  is  given  to  the  sick 
by  foolish  people.  When  you  see  the  natural  and  almost 
universal  craving  in  English  sick  for  their  "  tea,"  you  cannot 
but  feel  that  nature  knows  what  she  is  about.  But  a  little 
tea  or  coifee  restores  them  quite  as  much  as  a  great  deal, 
and  a  great  deal  of  tea  and  especially  of  coffee  impairs  the 
little  power  of  digestion  they  have.  Yet  a  nurse,  because 
she  sees  how  one  or  two  cups  of  tea  or  coffee  restoresLher 
patient,  thinks  that  three  or  four  cups  will  do  twice  as 
much.  This  is  not  the  case  at  all ;  it  is  however  certain 
that  there  is  nothing  yet  discovered  which  is  a  substitute 
to  the  English  patient  for  his  cup  of  tea ;  he  can  take  it 
when  he  can  take  nothing  else,  and  he  often  can't  take 
anything  else  if  he  has  it  not.  I  should  be  very  glad  if  any 
of  the  abusers  of  tea  would  point  out  what  to  give  to  an 
English  patient  after  a  sleepless  night,  instead  of  tea.  If 
you  give  it  at  five  or  six  o'clock  in  the  morning,  he  may 
even  sometimes  fall  asleep  after  it,  and  get  perhaps  his  only 
two  or  three  hours'  sleep  during  the  twenty-four.  At  the 
same  time  you  never  should  give  tea  or  coffee  to  the  sick, 
as  a  rule,  after  five  o'clock  in  the  afternoon.  Sleeplessness 
in  the  early  night  is  from   excitement  generally  and   is 

*  It  is  made  a  frequent  recommendation  to  persons  about  to  incur 
great  exhaustion,  either  from  the  nature  of  the  service,  or  from  their 
being  not  in  a  state  fit  for  it,  to  eat  a  piece  of  bread  before  they  go.  I 
wish  the  recommenders  would  themselves  try  the  experiment  of  substi- 
tuting a  piece  of  bread  for  a  cup  of  tea  or  coffee,  or  beef  tea,  as  a 
refresher.  They  M^ould  find  it  a  very  poor  comfort.  When  soldiers 
have  to  set  out  fasting  on  fatiguing  duty,  when  nurses  have  to  go  fast- 
ing in  to  their  patients,  it  is  a  hot  restorative  they  want,  and  ought  to 
have,  before  they  go,  not  a  cold  bit  of  bread.  And  dreadful  have  been 
the  consequences  of  neglecting  this.  If  they  can  take  a  bit  of  bread 
with  the  hot  cup  of  tea,  so  much  the  better,  but  not  instead  of  it.  The 
fact  that  there  is  more  nourishment  in  bread  than  in  almost  anything 
else,  has  probably  induced  the  mistake.  That  it  is  a  fatal  mistake, 
there  is  no  doubt.  It  seems,  though  very  little  is  known  on  the  subject, 
that  what  "assimilates"  itself  directly,  and  with  the  least  trouble  of 
digestion  with  the  human  body,  is  the  best  for  the  above  circiimstances. 
Bread  requires  two  or  three  processes  of  assimilation,  before  it  becomes 
like  the  human  body. 

The  almost  universal  testimony  of  English  men  and  women  who  have 
undergone  great  fatigue,  such  as  riding  long  journeys  without  stopping, 
or  sitting  up  for  several  nights  in  succession,  is  that  they  could  do  it 
best  upon  an  occasional  cup  of  tea  —  and  nothing  else. 

Let  experience,  not  theory,  decide  upon  this  as  uj^on  all  other  things. 


WHAT  FOOD?  69 

increased  by  tea  or  coffee ;  sleeplessness  which  continues 
to  the  early  morning  is  from  exhaustion  often,  and  is  re- 
lieved by  tea.  The  only  English  patients  I  have  ever 
known  refuse  tea,  have  been  typhus  cases,  and  the  first  sign 
of  their  getting  better  was  their  craving  again  for  tea.  In 
general,  the  dry  and  dirty  tongue  always  prefers  tea  to  cof- 
fee, and  will  quite  decline  milk,  unless  with  tea.  Coffee  is 
a  better  restorative  than  tea,  but  a  greater  impairer  of  the 
digestion.  Let  the  patient's  taste  decide.  You  will  say 
that,  in  cases  of  great  thirst,  the  patient's  craving  decides 
that  it  will  drink  a  great  deal  of  tea,  and  that  you  cannot 
help  it.  But  in  these  cases  be  sure  that  the  patient 
requires  diluents  for  quite  other  purposes  than  quenching 
the  thirst ;  he  wants  a  great  deal  of  some  drink,  not  only 
of  tea,  and  the  doctor  will  order  what  he  is  to  have,  bar- 
ley water  or  lemonade,  or  soda  water  and  milk,  as  the  case 
may  be. 

Lehman,  quoted  by  Dr.  Christison,  says  that,  among  the 
well  and  active  "  the  infusion  of  1  oz.  of  roasted  coffee  daily 
will  diminish  the  waste "  going  on  in  the  body  "  by  one- 
fourth,"  and  Dr.  Christison  adds  that  tea  has  the  same 
property.  Now  this  is  actual  experiment.  Lehman  weighs 
the  man  and  finds  the  fact  from  his  weight.  It  is  not 
deduced  from  any  "analysis"  of  food.  All  experience 
among  the  sick  shows  the  same  thing.* 

Cocoa  is  often  recommended  to  the  sick  in  lieu  of  tea  or 
coffee.     But  independently  of  the  fact  that  English  sick 

*  In  making  coffee,  it  is  absolutely  necessary  to  buy  it  in  the  berry 
and  grind  it  at  home.  Otherwise  you  may  reckon  upon  its  contahiing 
a  certain  amount  of  chiccory,  at  least.  This  is  not  a  question  of  the 
taste  or  the  wholcsomeness  of  chiccory.  It  is  that  chiccory  has  nothing 
at  all  of  the  properties  for  which  you  give  coffee.*  And  therefore  you 
may  as  well  not  give  it. 

Again,  all  laundresses,  mistresses  of  dairy-farms,  head  nurses,  (I 
speak  of  the  good  old  sort  only  —  women  who  \mite  a  good  deal  of  hard 
manual  labor  with  the  head-work  necessary  for  arranging  the  day's 
business,  so  that  none  of  it  shall  tread  upon  the  heeU  of  something 
else,)  set  great  value,  I  have  observed,  upon  having  a  high-priced  tea. 
This  is  called  extravagant.  But  these  women  are  "extravagant"  in 
nothing  else.  And  they  are  right  in  this.  Real  tea-leaf  tea  alone  con- 
tains the  restorative  they  want ;  which  is  not  to  be  fovmd  in  sloe-leaf  tea. 

The  mivStresses  of  houses,  who  cannot  even  go  over  their  own  house 
once  a  day,  are  iAcapable  of  judging  for  these  women.  For  they  are 
incapable  themselves,  to  all  appearance,  of  the  spirit  of  arrangement 
(no  small  task)  necessary  for  managing  a  large  ward  or  dairy. 


6.0  NOTES   ON   NURSING. 

very  generally  dislike  cocoa,  it  has  quite  a  different  effect 
from  tea  or  coffee.  It  is  an  oily  starchy  nut  having  no 
restorative  power  at  all,  but  simply  increasing  fat.  It  is 
pure  mockery  of  the  sick,  therefore,  to  call  it  a  substitute 
for  tea.  For  any  renovating  stimulus  it  has,  you  might 
just  as  well  offer  them  chestnuts  instead  of  tea. 

An  almost  universal  error  among  nurses  is  in  the  bulk 
of  the  food  and  especially  the  drinks  they  offer  to  their 
patients.  Suppose  a  patient  ordered  4  oz.  brandy  during 
the  day,  how  is  he  to  take  this  if  you  make  it  into  four 
pints  with  diluting  it  ?  The  same  with  tea  and  beef  tea, 
with  arrowroot,  milk,  &c.  You  have  not  increased  the 
nourishment,  you  have  not  increased  the  renovating  power 
of  these  articles,  by  increasing  their  bulk,  —  you  have  very 
likely  diminished  both  by  giving  the  patient's  digestion 
more  to  do,  and  most  likely  of  all,  the  patient  will  leave 
half  of  what  he  has  been  ordered  to  take,  because  he  can- 
not swallow  the  bulk  with  which  you  have  been  pleased  to 
invest  it.  It  requires  very  nice  observation  and  care  (and 
meets  with  hardly  any)  to  determine  what  will  not  be  too 
thick  or  strong  for  the  patient  to  take,  while  giving  him  no 
more  than  the  bulk  which  he  is  able  to  swallow. 


Vm.    BED  AXD   BEDDING. 

A  few  words  upon  bedsteads  and  bedding ;  and  princi- 
pally as  regards  patients  who  are  entirely,  or  almost 
entirely,  confined  to  bed. 

Feverishness  is  generally  supposed  to  be  a  sjnnptom  of 
fever  —  in  nine  cases  out  often  it  is  a  symptom  of  bedding.* 
The  patient  has  had  re-introduced  into  the  body  the  ema- 
nations from  himself  which  day  after  day  and  week  after 
week  saturate  his  unaired  bedding.  How  can  it  be  other- 
wise ?     Look  at  the  ordinary  bed  in  which  a  patient  lies. 

If  I  were  looking  out  for  an  example  in  order  to  show 
what  7iot  to  do,  I  should  take  the  specimen  of  an  ordinary 

*  I  once  told  a  "very  good  niirse "  that  the  way  in  which  her 
patient's  room  was  kept  was  quite  enough  to  account  for  her  sleepless- 
ness ;  and  she  answered  quite  good-humoredly  she  was  not  at  all  sur- 
prised at  it  —  as  if  the  state  of  the  room  were,  like  the  state  of  the 
weather,  entirely  out  of  her  power.  Now  in  what  sense  was  this 
woman  to  be  culled  a  •'  nurse  ?  " 


BED   AND   BEDDING.  61 

bed  in  a  private  house :  a  wooden  bedstead,  two  or  even 
three  mattresses  piled  up  to  above  the  height  of  a  table ;  a 
vallance  attached  to  the  frame  —  nothing  but  a  miracle 
could  ever  thoroughly  dry  or  air  such  a  bed  and  bedding. 
The  patient  must  inevitably  alternate  between  cold  damp 
after  his  bed  is  made,  and  warm  damp  before,  both  satu- 
rated with  organic  matter,*  and  this  from  the  time  the 
mattresses  are  put  under  him  till  the  time  they  are  picked 
to  pieces,  if  this  is  ever  done. 

If  you  consider  that  an  adult  in  health  exhales  by  the 
lungs  and  skin  in  the  twenty-four  hours  three  pints  at  least 
of  moisture,  loaded  with  organic  matter  ready  to  enter  into 
putrefaction ;  that  in  sickness  the  quantity  is  often  greatly 
increased,  the  quahty  is  always  more  noxious — just  ask 
yourself  next  where  does  all  this  moisture  go  to  ?  Chiefly 
into  the  bedding,  because  it  cannot  go  anywhere  else. 
And  it  stays  there;  because,  except  perhaps  a  weekly 
change  of  sheets,  scarcely  any  other  airing  is  attempted. 
A  nurse  will  be  careful  to  fidgetiness  about  airing  the  clean 
sheets  from  clean  damp,  but  airing  the  dirty  sheets  from 
noxious  damp  will  never  even  occur  to  her.  Besides  this, 
the  most  dangerous  eflluvia  we  know  of  are  from  the 
excreta  of  the  sick  —  these  are  placed,  at  least  temporarily, 
where  they  must  throw  their  eflluvia  into  the  under  side 
of  the  bed,  and  the  space  under  the  bed  is  never  aired ;  it 
cannot  be,  with  our  arrangements.  Must  not  such  a  bed 
be  always  saturated,  and  be  always  the  means  of  re-intro- 
ducing into  the  system  of  the  unfortunate  patient  who  lies 
in  it,  that  excrementitious  matter  to  eliminate  which  from 
the  body  nature  had  expressly  appointed  the  disease  ? 

My  heart  always  sinks  within  me  when  I  hear  the  good 
house-wife,  of  every  class,  say,  "  I  assure  you  the  bed  has 
been  well  slept  in,"  and  I  can  only  hope  it  is  not  true. 
What  ?  is  the  bed  already  saturated  with  somebody  else's 
damp  before  my  patient  comes  to  exhale  in  it  his  own 
damp?  Has  it  not  had  a  single  chance  to  be  aired?  No, 
not  one.     "  It  has  been  slept  in  every  night." 

*  For  the  same  reason  if,  after  -washing  a  patient,  yoxi  must  put  the 
same  night-dress  on  him  again,  always  give  it  a  preliminary  warm  at 
the  fire.  The  night-gown  he  has  worn  must  be,  to  a  certain  extent, 
damp.  It  has  now  got  cold  from  having  been  off  him  for  a  few  min- 
utes. The  fire  will  dry  and  at  tlie  same  time  air  it.  This  is  much  more 
important  than  with  clean  things. 

6 


62  NOTES    ON   NURSING. 

The  only  way  of  really  nursing  a  real  patient  is  to  have  an 
iron  bedstead,  with  rheocline  springs,  which  are  permeable 
by  the  air  up  to  the  very  mattress  (no  vallance,  of  course), 
the  mattress  to  be  a  thin  hair  one ;  the  bed  to  be  not  above 
3^  feet  wide.  If  the  patient  be  entirely  confined  to  his  bed, 
there  should  be  ti/)o  such  bedsteads;  each  bed  to  be 
"  made  "  with  mattress,  sheets,  blankets,  <fcc.,  complete  — 
the  patient  to  pass  twelve  hours  in  each  l)ed ;  on  no  account 
to  carry  his  sheets  with  him.  The  whole  of  the  bedding 
to  be  hung  uj)  to  air  for  each  intermediate  twelve  hours. 
Of  course  there  are  many  cases  where  this  cannot  be  done 
at  all  —  many  more  where  only  an  approach  to  it  can  be 
made.  I  am  indicating  the  ideal  of  nursing,  and  what  I 
have  actually  had  done.  But  about  the  kind  of  bedstead 
there  can  be  no  doubt,  whether  there  be  one  or  two 
provided. 

There  is  a  prejudice  in  favor  of  a  wide  bed  —  I  believe 
it^to  be  a  prejudice.  All  the  refreshment  of  moving  a 
patient  from  one  side  to  the  other  of  his  bed  is  far  more 
effectually  secured  by  putting  him  into  a  fresh  bed ;  and  a 
patient  w^ho  is  really  very  ill  does  not  stray  far  in  bed. 
But  it  is  said  there  is  no  room  to  put  a  tray  down  on  a 
narrow  bed.  No  good  nurse  will  ever  put  a  tray  on  a  bed 
at  all.  If  the  patient  can  turn  on  his  side,  he  will  eat  more 
comfortably  from  a  bed-side  table ;  and  on  no  account 
whatever  should  a  bed  ever  be  higher  than  a  sofa.  Other- 
w^ise  the  patient  feels  himself  "  out  of  humanity's  reach  ; " 
he  can  get  at  nothing  for  himself:  he  can  move  nothing 
for  himself.  If  the  j^atient  cannot  turn,  a  table  over  the 
bed  is  a  better  thing.  I  need  hardly  say  that  a  patient's 
bed  should  never  have  its  side  against  the  wall.  The  nurse 
must  be  able  to  get  easily  to  both  sides  of  the  bed,  and  to 
reach  easily  every  part  of  the  patient  without  stretching  — 
a  thing  impossible  if  the  bed  be  either  too  wide  or  too  high. 

When  I  see  a  patient  in  a  room  nine  or  ten  feet  high 
upon  a  bed  between  four  and  five  feet  high,  with  his  head, 
when  he  is  sitting  up  in  bed,  actually  within  two  or  three 
feet  of  the  ceiling,  I  ask  myself,  is  this  expressly  planned 
to  produce  that  peculiarly  distressing  feeUng  common  to 
the  sick,  viz.,  as  if  the  walls  and  ceiling  were  closing  in 
upon  them,  and  they  becoming  sandwiches  between  floor 
and  ceiling,  which  imagination  is  not,  indeed,  here  so  far 
from  the  truth  ?     If,  over  and  above  this,  the  window  stops 


BED   AND   BEDDING.  63 

short  of  the  ceiling,  then  the  patient's  head  may  literally 
be  raised  above  the  stratum  of  fresh  air,  even  when  the 
window  is  open.  Can  human  perversity  any  farther  go, 
in  unmaking  the  process  of  restoration  which  God  has 
made  ?  The  flict  is,  that  the  heads  of  sleepers  or  of  sick 
should  never  be  higher  than  the  throat  of  the  chimney, 
which  ensures  their  being  in  the  current  of  best  air.  And 
we  will  not  suppose  it  possible  that  you  have  closed  your 
chimney  with  a  chimney-board. 

If  a  bed  is  higher  than  a  sofa,  the  diiference  of  the 
fatigue  of  getting  in  and  out  of  bed  will  just  make  the 
difference,  very  often,  to  the  patient  (who  can  get  in  and 
out  of  bed  at  all)  of  being  able  to  take  a  few  minutes'  exer- 
cise, either  in  the  open  air  or  in  another  room.  It  is  so 
very  odd  that  people  never  think  of  this,  or  of  how  many 
more  times  a  patient  who  is  in  bed  for  the  twenty-four 
hours  is  obliged  to  get  in  and  out  of  bed  than  they  are,  Avho 
only,  it  is  to  be  hoped,  get  into  bed  once  and  out  of  bed 
once  during  the  twenty-four  hours. 

A  patient's  bed  should  always  be  in  the  lightest  spot  in 
the  room ;  and  he  should  be  able  to  see  out  of  window. 

I  need  scarcely  say  that  the  old  four-post  bed  with  cur- 
tains is  utterly  inadmissible,  whether  for  sick  or  well.  Hos- 
pital bedsteads  are  in  many  respects  very  much  less  objec- 
tionable than  private  ones. 

There  is  reason  to  believe  that  not  a  few  of  the  appar- 
ently unaccountable  cases  of  scrofula  among  children  pro- 
ceed from  the  habit  of  sleeping  with  the  head  under  the 
bed  clothes,  and  so  inhaling  air  already  breathed,  which  is 
farther  contaminated  by  exhalations  from  the  skin.  Pa- 
tients are  sometimes  given  to  a  similar  habit,  and  it  often 
happens  that  the  bed  clothes  are  so  disposed  that  the 
patient  must  necessarily  breathe  air  more  or  less  contami- 
nated by  exhalations  from  his  skin.  A  good  nurse  will  be 
careful  to  attend  to  this.  It  is  an  important  part,  so  to 
sj^eak,  of  ventilation. 

It  may  be  worth  while  to  remark,  that  where  there  is 
any  danger  of  bed-sores  a  blanket  should  never  be  placed 
under  the  patient.  It  retains  dam^)  and  acts  like  a  poul- 
tice. 

ISTever  use  anything  but  light  Whitney  blankets  as  bed 
covei-ing  for  the  sick.  The  heavy  cotton  impervious  coun- 
terpane is  bad,  for  the  very  reason  that  it  keeps  in  the 


64  NOTES   ON   NURSING. 

emanations  from  the  sick  person,  while  the  blanket  allows 
them  to  pass  through.  AVeak  patients  are  invaiiably  dis- 
tressed by  a  great  weight  of  bed  clothes,  which  often  pre- 
vents their  getting  any  sound  sleep  whatever. 

Note.  —  One  word  about  pillows.  Every  weak  patient,  be  his  ill- 
ness what  it  may,  suffers  more  or  less  from  difficulty  in  breathing.  To 
take  the  weight  of  the  body  off  the  poor  chest,  which  is  hardly  up  to 
its  work  as  it  is,  ought  therefore  to  be  the  object  of  the  nurse  in  arrang- 
ing his  pillows.  Now  what  does  she  do  and  Avhat  are  the  conse- 
quences ?  She  piles  the  pillows  one  a-top  of  the  other  like  a  wall  of 
bricks.  The  head  is  thrown  upon  the  chest.  And  the  shoulders  are 
pushed  forward,  so  as  not  to  allow  the  lungs  room  to  expand.  The 
pillows,  in  fact,  lean  upon  the  patient,  not  the  patient  upon  the  pillows. 
It  is  impossible  to  give  a  rule  for  this,  because  it  must  vary  with  the 
figure  of  the  patient.  And  tall  patients  suffer  much  more  than  short 
ones,  because  of  the  drag  of  the  long  limbs  upon  the  waist.  But  the 
object  is  to  support,  with  the  pillows,  the  back  helow  the  breathing  ap- 
paratus, to  allow  the  shoulders  room  to  fall  back,  and  to  support  the 
head,  without  throwing  it  forward.  The  suffering  of  dying  patients  is 
immensely  increased  by  neglect  of  these  points.  And  many  an  invalid, 
too  weak  to  drag  about  his  pillows  himself,  slips  his  book  or  anything 
at  hand  behind  the  lower  part  of  his  back  to  support  it. 


IX.     LIGHT. 

It  is  the  unqualified  result  of  all  my  experience  with  the 
sick,  that  second  only  to  their  need  of  fi-esh  air  is  their 
need  of  light ;  that,  after  a  close  room,  what  hurts  them 
most  is  a  dark  room.  And  that  it  is  not  only  light  but 
sunlight  they  want.  I  had  rather  have  the  power  of  car- 
rying my  patient  about  after  the  sun,  according  to  the 
aspect  of  the  rooms,  if  circumstances  permit,  than  let  him 
linger  in  a  room  when  the  sun  is  off.  People  think  tlie 
effect  is  upon  the  spirits  only.  This  is  by  no  means  the 
case.  The  sun  is  not  only  a  j^ainter  but  a  sculptor.  You 
admit  that  he  does  the  photograph.  Without  going  into 
any  scientific  exposition  we  must  admit  that  hght  has  quite 
as  real  and  tangible  effects  upon  the  hitman  body.  But 
this  is  not  all.  Who  has  not  observed  the  j^urifying  effect 
of  light,  and  especially  of  direct  sunlight,  upon  the  air  of 
a  room  ?  Here  is  an  observation  within  everybody's  ex- 
perience. Go  into  a  room  where  the  shutters  are  always 
shut  (in  a  sick  room  or  a  bed-room  there  never  should  be 
shutters  shut,)  and  though  the  room  be  uninhabited,  though 


LIGHT.  65 

the  air  has  never  been  polluted  by  the  breathing  of  human 
beings,  you  will  observe  a  close,  musty  smell  of  corrupt  air, 
i.  e.  of  air  unpurified  by  the  effect  of  the  sun's  rays.  The 
mustiness  of  dark  rooms  and  corners,  indeed,  is  proverbial. 
The  cheerfulness  of  a  room,  the  usefulness  of  light  in  treat- 
ing disease  is  all-important.    > 

A  very  high  authority  in  hospital  construction  has  said 
that  people  do  not  enough  consider  the  difference  between 
wards  and  dormitories  in  planning  their  buildings.  But  I 
go  farther,  and  say,  that  healthy  people  never  remember 
the  difference  between  ^ec?-rooms  and  sicA-rooms,  in  mak- 
ing arrangements  for  the  sick.  To  a  sleeper  in  health  it 
does  not  signify  what  the  view  is  from  his  bed.  He  ought 
never  to  be  in  it  excepting  when  asleep,  and  at  night.  As- 
pect does  not  very  much  signify  either  (provided  the  sun 
reach  his  bed-room  some  time  in  every  day,  to  purify  the 
air),  because  he  ought  never  to  be  in  his  bed-room  except 
during  the  hours  when  there  is  no  sun.  But  the  case  is 
exactly  reversed  with  the  sick,  even  should  they  be  as 
many  hours  out  of  their  beds  as  you  are  in  yours,  which 
probably  they  are  not.  Therefore,  that  they  should  be 
able,  without  raising  themselves  or  turning  in  bed,  to  see 
out  of  window  from  their  beds,  to  see  sky  and  sunlight  at 
least,  if  you  can  show  them  nothing  else,  I  assert  to  be,  if 
not  of  the  very  first  importance  for  recovery,  at  least  some- 
thing very  near  it.  And  you  should  therefore  look  to  the 
position  of  the  beds  of  your  sick  one  of  the  very  first  things. 
If  they  can  see  out  of  two  windows  instead  of  one,  so  much 
the  better.  Again,  the  morning  sun  and  the  mid-day  sun 
—  the  hours  when  they  are  quite  certain  not  to  be  up,  are 
of  more  importance  to  them,  if  a  choice  must  be  made, 
than  the  afternoon  sun.  Perhaps  you  can  take  them  out 
of  bed  in  the  afternoon  and  set  them  by  the  window,  where 
they  can  see  the  sun.  But  the  best  rule  is,  if  possible,  to 
give  them  direct  sunlight  from  the  moment  he  rises  till  the 
moment  he  sets. 

Another  great  difference  between  the  hed-YOom.  and  the 
sick-Yooxn.  is,  that  the  sleeper  has  a  very  large  balance  of 
fresh  air  to  begin  with,  when  he  be*gins  the  night,  if  his 
room  has  been  open  all  day  as  it  ought  to  be  ;  the  sick  man 
has  not,  because  all  day  he  has  been  breathing  the  air  in 
the  same  room,  and  dirtying  it  by  the  emanations  from 
6* 


66  NOTES   ON   NURSING. 

himself.  Far  more  care  is  therefore  necessary  to  keep  up 
a  constant  change  of  air  in  the  sick-room. 

It  is  hardly  necessary  to  add  that  there  are  acute  cases 
(particularly  a  few  ophthalmic  cases,  and  diseases  where 
the  eye  is  morbidly  sensitive),  where  a  subdued  light  is 
necessary.  But  a  dark  north  room  is  inadmissible  even 
for  these.  You  can  always  moderate  the  light  by  blinds 
and  curtains. 

Heavy,  thick,  dark  window  or  bed  curtains  should,  how- 
ever, hardly  ever  be  used  for  any  kind  of  sick  in  this  coun- 
try. A  light  white  curtain  at  the  head  of  the  bed  is,  in 
general,  all  that  is  necessary,  and  a  green  blind  to  the 
window,  to  be  drawn  down  only  when  necessary. 

One  of  the  greatest  observers  of  human  things  (not  phys- 
iological), says,  in  another  language,  "Where  there  is  sun 
there  is  thought."  All  physiology  goes  to  confirm  this. 
Where  is  the  shady  side  of  deep  vallies,  there  is  cretinism. 
Where  are  cellai's  and  the  unsunned  sides  of  narrow  streets, 
there  is  the  degeneracy  and  w^eakliness  of  the  human  race 

—  mind  and  body  equally  degenerating.  Put  the  pale 
withering  plant  and  human  being  into  the  sun,  and,  if  not 
too  fir  gone,  each  will  recover  health  and  spirit. 

It  is  a  curious  thing  to  observe  how  almost  all  patients 
lie  with  their  faces  turned  to  the  light,  exactly  as  plants 
always  make  their  way  towards  the  light;  a  patient  will 
even  complain  that  it  gives  him  pain  "  lying  on  that  side." 
"Then  why  do  you  lie  on  that  side?"     He  does  not  know, 

—  but  we  do.  It  is  because  it  is  the  side  towards  the 
window.  A  fashionable  physician  has  recently  published 
in  a  government  report  that  he  always  turns  his  patients' 
faces  from  the  light.  Yes,  but  nature  is  stronger  than  fash- 
ionable physicians,  and  depend  upon  it  she  turns  the  faces 
back  and  toicards  such  light  as  she  can  get.  Walk  through 
the  wards  of  a  hospital,  remember  the  bed  sides  of  private 
patients  you  have  seen,  and  count  how  many  sick  you  ever 
saw  l^ing  with  their  faces  towards  the  wall. 


X.     CLEANLINESS   OF  ROOMS   AND   WALLS. 

It  cannot  be  necessary  to  tell  a  nurse  that  she  should  be 
clean,  or  that  she  should  keep  her  patient  clean,  —  seeing 
that   the  greater   part  of  nursing  consists   in  preserving 


CLEANLINESS   OF   ROOMS   AND   WALLS.  67 

cleanliness.  No  ventilation  can  freshen  a  room  or  ward 
where  the  most  scrupulous  cleanliness  is  not  observed. 
Unless  the  wind  be  blowing  through  the  windows  at  the 
rate  of  twenty  miles  an  hour,  dusty  carpets,  dirty  wainscots, 
musty  curtains  and  furniture,  will  infalhbly  produce  a  close 
smell.  I  have  lived  in  a  large  and  expensively  furnished 
London  house,  where  the  only  constant  inmate  in  two  very 
lofty  rooms,  with  opposite  windows,  was  myself,  and  yet, 
owing  to  the  above-mentioned  dirty  circumstances,  no  open- 
ing of  windows  could  ever  keep  those  rooms  free  from  close- 
ness ;  but  the  carpet  and  curtains  having  been  turned  out 
of  the  rooms  altogether,  they  became  instantly  as  fresh  as 
could  be  wished.  It  is  pure  nonsense  to  say  that  in  Lon- 
don a  room  cannot  be  kept  clean.  Many  of  our  hosj^itals 
show  the  exact  reverse. 

But  no  particle  of  dust  is  ever  or  can  ever  be  removed 
or  really  got  rid  of  by  the  present  system  of  dusting. 
Dusting  in  these  days  means  nothing  but  flapping  the  dust 
from  one  part  of  a  room  to  another  with  doors  and  win- 
dows closed.  What  you  do  it  for  I  cannot  think.  You 
had  much  better  leave  the  dust  alone,  if  you  are  not  going 
to  take  it  away  altogether.  For  from  the  time  a  room  be- 
gins to  be  a  room  up  to  the  time  when  it  ceases  to  be  one, 
no  one  atom  of  dust  ever  actually  leaves  its  precincts. 
Tidying  a  room  means  nothing  now  but  removing  a  thing 
from  one  place,  which  it  has  kept  clean  for  itself,  on  to  an- 
other and  a  dirtier  one.*  Flapping  by  way  of  cleaning  is 
only  admissible  in  the  case  of  pictures,  or  anything  made 
o£  paper.  The  only  way  i  know  to  remove  dust,  the  plague 
of  all  lovers  of  fresh  air,  is  to  wipe  everything  with  a  damp 
cloth.     And  all  furniture  ouo-ht  to  be  so  made  as  that  it 


*  If  you  like  to  clean  your  furniture  by  laying  out  your  clean  clothes 
upon  yoiir  dirty  chairs  or  sofa,  this  is  one  way  certainly  of  doing  it. 
Having  witnessed  the  morning  process  called  "tidying  the  room"  for 
many  years,  and  with  ever-increasing  astonishment,  I  can  describe 
what  it  is.  From  the  chairs,  tables,  or  sofa,  upon  which  the  '*  things" 
have  lain  during  the  night,  and  which  are  therefore  comparatively  clean 
from  dust  or  blacks,  the  poor  ^^  things"  having  "caught"  it,  they  are 
removed  to  other  chairs,  tables,  solas,  upon  which  you  could  write 
your  name  with  your  finger  in  the  dust  or  blacks.  The  other  side  of  the 
"things"  is  therefore  now  evenly  dirtied  or  dusted.  The  housemaid 
then  tlaps  everything,  or  some  things,  not  out  of  her  reach,  with  a  thing 
called  a  duster  —  the  dust  flies  up,  then  re-settles  more  equally  than  it 
lay  before  the  operation.     The  room  has  now  been  "  put  to  rights." 


68  NOTES   ON    NURSING. 

may  be  wiped  with  a  damp  cloth  without  injury  to  itself 
and  so  polislied  as  that  it  may  be  damped  without  injury 
to  others.  To  dust,  as  it  is  now  practised,  truly  means  to 
distribute  dust  more  equally  over  a  room. 

As  to  floors,  the  only  really  clean  floor  I  know  is  the 
Berlin  lackered  floor,  which  is  wet  rubbed  and  dry  rubbed 
every  morning  to  remove  the  dust.  The  YY(i,wQ\\  parquet 
is  always  more  or  less  dusty,  although  infinitely  superior 
in  point  of  cleanliness  and  healthiness  to  our  absorbent 
floor. 

For  a  sick  room,  a  carpet  is  jierhaps  the  worst  expedient 
which  could  by  any  possibility  have  been  invented.  If  you 
must  have  a  carpet,  the  only  safety  is  to  take  it  up  two  or 
three  times  a  year,  instead  of  once.  A  dirty  carpet  liter- 
ally infects  the  room.  And  if  you  consider  the  enormous 
quantity  of  organic  matter  from  the  feet  of  people  coming 
in,  which  must  saturate  it,  this  is  by  no  means  surprising. 

As  for  walls,  the  worst  is  the  papered  wall;  the  next 
worst  is  plaster.  But  the  plaster  can  be  redeemed  by  fre- 
quent lime-washing;  the  paper  requires  frequent  renewing. 
A  glazed  paper  gets  rid  of  a  good  deal  of  the  danger. 
But  the  ordinary  bed-room  paper  is  all  that  it  ought  not 
to  be.* 

The  close  connection  between  ventilation  and  cleanli- 
ness is  shown  in  this.  An  ordinary  light  paper  will  last 
clean  much  longer  if  there  is  an  Arnott's  ventilator  in  the 
chimney  than  it  otherwise  would. 

The  best  wall  now  extant  is  oil  paint.  From  this  you 
can  wash  the  animal  exuvi£e.  t     • 

These  are  what  make  a  room  musty. 

The  best  wall  for  a  sick-room  or  ward  that  could  be 
made  is  pure  white  non-absorbent  cement  or  glass,  or 
glazed  tiles,  if  they  were  made  sightly  enough. 

Air  can  be  soiled  just  like  water.  If  3'ou  blow  into  wa- 
ter you  will  soil  it  with  the  animal  matter  from  your  breath. 

*  I  am  sure  that  a  person  who  has  accustomed  her  senses  to  compare 
atmospheres  proper  and  improper,  for  the  sick  and  for  children,  could 
tell,  blindfold,  the  difference  of  the  air  in  old  painted  and  in  old  papered 
rooms,  ccetcris  paribus.  The  latter  "will  always  be  musty,  even  with  all 
the  windows  open. 

t  K  you  like  to  wipe  your  dirty  door,  or  some  portion  of  your  dirty 
wall,  by  hanging  up  your  clean  gown  or  shawl  against  it  on  a  peg,  this 
is  one  way  certainly,  and  the  most  usual  way,  and  generally  the  only 
way  of  cleaning  either  door  or  wall  in  a  bed-room ! 


CLEANLLNESS   OF   ROOMS   AND    WALLS.  69 

So  it  is  with  air.     Air  is  always  soiled  in  a  room  where 
walls  and  carpets  are  saturated  with  animal  exhalations. 

Want  of  cleanliness,  then,  in  rooms  and  wards,  which 
you  have  to  guard  against,  may  arise  in  three  ways. 

1.  Dirty  air  coming  in  from  without,  soiled  by  sewer 
emanations,  the  evaporation  from  dirty  streets,  smoke,  bits 
of  unburnt  fuel,  bits  of  straw,  bits  of  horse  dung. 

If  people  would  but  cover  the  outside  walls  of  their 
houses  with  plain  or  encaustic  tiles,  what  an  incalculable 
improvement  would  there  be  in  light,  cleanliness,  dryness, 
warmth,  and  consequently  economy.  The  play  of  a  fire- 
engine  would  then  effectually  wash  the  outside  of  a  house. 
This  kind  of  icalling  would  stand  next  to  paving  in  improv- 
ing the  health  of  towns. 

2.  Dirty  air  coming  from  within,  from  dust,  which  you 
often  displace,  but  never  remove.  And  this  recalls  what 
ought  to  be  a  sine  qua  non.  Have  as  few  ledges  in  your 
room  or  ward  as  possible.  And  under  no  pretence  have 
any  ledge  whatever  out  of  sight.  Dust  accumulates  there, 
and  will  never  be  wiped  oif.  This  is  a  certain  way  to  soil 
the  air.  Besides  this,  the  animal  exhalations  from  your 
inmates  saturate  your  furniture.  And  if  you  never  clean 
your  furniture  properly,  how  can  your  rooms  or  wards  be 
anything  but  musty  ?  Ventilate  as  you  please,  the  rooms 
will  never  be  sweet.  Besides  this,  there  is  a  constant 
degradation^  as  it  is  called,  taking  place  from  everything 
except  polished  or  glazed  articles  —  e.  ^.,  in  coloring  cer- 
tain green  papers  arsenic  is  used.  Now  in  the  very  dust 
even,  which  is  lying  about  in  rooms  hung  with  this  kind  of 
green  paper,  arsenic  has  been  distinctly  detected.  You  see 
your  dust  is  anything  but  harmless ;  yet  you  will  let  such 
dust  lie  about  your  ledges  for  months,  your  rooms  forever. 

Again,  the  fire  fills  the  room  with  coal  dust. 

3.  Dirty  air  coming  from  the  carpet.  Above  all,  take 
care  of  the  carpets,  that  the  animal  dirt  left  there  by  the 
feet  of  visitors  does  not  stay  there.  Floors,  unless  the 
grain  is  filled  up  and  polished,  are  just  as  bad.  The  smell 
from  the  floor  of  a  school-room  or  ward,  when  any  mois- 
ture brings  out  the  organic  matter  by  which  it  is  satui-ated, 
might  alone  be  enougli  to  warn  us  of  the  mischief  that  is 
going  on. 

The  outer  air,  then,  can  oidy  be  kept  clean  by  sanitary 
improvements,  and  by  consuming  smoke.     The  expense  in 


70  NOTES   ON   NURSING. 

soap,  which  this  single  improvement  would  save,  is  quite 
incalculable. 

The  inside  air  can  only  be  kept  clean  by  excessive  care 
in  the  ways  mentioned  above — to  rid  the  walls,  carpets, 
furniture,  ledges,  &C.,  of  the  organic  matter  and  dust  — 
dust  consisting  gTcatly  of  this  organic  matter — with  which 
they  become  saturated,  and  which  is  what  really  makes  the 
room  musty. 

Without  cleanliness,  you  cannot  have  all  the  effect  of 
ventilation ;  without  ventilation,  you  can  have  no  thorough 
cleanliness. 

Very  few  people,  be  they  of  what  class  they  may,  have 
any  idea  of  the  exquisite  cleanliness  required  in  the  sick- 
room. For  much  of  what  I  have  said  applies  less  to  the 
hospital  than  to  the  private  sick-room.  The  smoky  chim- 
ney, the  dusty  furniture,  the  utensils  emptied  but  once  a 
day,  often  keep  the  air  of  the  sick  constantly  dirty  in  the 
best  private  houses. 

The  well  have  a  curious  habit  of  forgetting  that  what  is 
to  them  but  a  trifling  inconvenience,  to  be  patiently  "put 
up"  with,  is  to  the  sick  a  source  of  suffering,  delaying 
recovery,  if  not  actually  hastening  death.  The  well  are 
scarcely  ever  more  than  eight  hours,  at  most,  in  the  same 
room.  Some  change  they  can  always  make,  if  only  for  a 
few  minutes.  Even  during  the  supposed  eight  hours,  they 
can  change  their  posture  or  their  position  in  the  room.  But 
the  sick  man,  who  never  leaves  his  bed,  Avho  cannot  change 
by  any  movement  of  his  own  his  air,  or  his  light,  or  his 
warmth  ;  who  cannot  obtain  quiet,  or  get  out  of  the  smoke, 
or  the  smell,  or  the  dust ;  he  is  really  poisoned  or  depressed 
by  what  is  to  you  the  merest  trifle. 

"  What  can't  be  cured  must  be  endured,"  is  the  very 
worst  and  most  dangerous  maxim  for  a  nurse  which  ever 
was  made.  Patience  and  resignation  in  her  are  but  other 
words  for  carelessness  or  indifference  —  contemptible,  if  in 
regard  to  herself;  culpable,  if  in  regard  to  her  sick. 


XI.     PERSONAL   CLEANLINESS. 

In  almost  all  diseases,  the  function  of  the  skin  is,  more 
or  less,  disordered ;  and  in  many  most  important  diseases 
nature  relieves  herself  almost  entirely  by  the  skin,     This 


PERSONAL   CLEANLINESS.  ll 

is  particularly  the  case  with  children.  But  the  excretion, 
which  comes  from  the  skin,  is  left  there,  unless  removed  by 
washing  or  by  the  clothes.  Every  nurse  should  keep  this 
fact  constantly  in  mind,  —  for,  if  she  allow  her  sick  to  re- 
main unwashed,  or  their  clotliing  to  remain  on  them  after 
being  saturated  with  perspiration  or  other  excretion,  she  is 
interfering  injuriously  with  the  natural  processes  of  health 
just  as  eftectually  as  if  she  were  to  give  the  patient  a  dose 
of  slow  poison  by  the  mouth.  Poisoning  by  the  skin  is 
no  less  certain  than  poisoning  by  the  mouth  —  only  it  is 
slower  in  its  operation. 

The  amount  of  relief  and  comfort  experienced  by  sick 
after  the  skin  has  been  carefully  washed  and  dried,  is  one 
of  the  commonest  observations  made  at  a  sick  bed.  But 
it  must  not  be  forgotten  that  the  comfort  and  relief  so  ob- 
tained are  not  all.  They  are,  in  fact,  nothing  more  than  a 
sign  that  the  vital  powers  have  been  relieved  by  removing 
something  that  was  oppressing  them.  The  nurse,  therefore, 
must  never  put  off  attending  to  the  personal  cleanliness 
of  her  patient  under  the  plea  that  all  that  is  to  be  gained 
is  a  little  relief,  which  can  be  quite  as  well  given  later. 

In  all  well-regulated  hospitals  this  ought  to  be,  and  gen- 
erally is,  attended  to.  But  it  is  very  generally  neglected 
with  private  sick. 

Just  as  it  is  necessary  to  renew  the  air  round  a  sick  per- 
son frequently,  to  carry  off  morbid  effluvia  from  the  lungs 
and  skin,  by  maintaining  free  ventilation,  so  it  is  necessary 
to  keep  the  pores  of  the  skin  free  from  all  obstructing 
excretions.  The  object,  both  of  ventilation  and  of  skin- 
cleanliness,  is  pretty  much  the  same,  —  to  wit,  removing 
noxious  matter  from  the  system  as  rapidly  as  possible. 

Cai-e  should  be  taken  in  all  tliese  o]>erations  of  sponging, 
washing,  and  cleansing  the  skin,  not  to  expose  too  great 
a  surface  at  once,  so  as  to  check  the  perspiration,  wliich 
would  renew  tlie  evil  in  another  form. 

The  various  ways  of  wasliing  the  sick  need  not  here  be 
specilied, — the  less  so  as  the  doctors  ought  to  say  which 
is  to  be  used. 

In  several  forms  of  diar]-ha?a,  dysentery,  &c.,  where  the 
skin  is  hard  and  harsh,  the  relief  afforded  by  washing  with 
a  great  deal  of  soft  soap  is  incalcuhible.  In  otlier  cases, 
sponging  with  tepid  soap  and  water,  then  with  tepid  water 
and  drying  Avith  a  hot  towel  will  be  ordered. 


72  NOTES   ON   NURSING. 

Every  nurse  ought  to  be  careful  to  wash  her  hands  very 
frequently  during  the  day.  If  her  face  too,  so  much  the 
better. 

One  word  as  to  cleanUness  merely  as  cleanliness. 

Compare  the  dirtiness  of  the  water  in  which  you  have 
washed  when  it  is  cold  without  soap,  cold  with  soap,  hot 
with  soap.  You  will  find  the  first  has  hardly  removed  any 
dirt  at  all,  the  second  a  little  more,  the  third  a  great  deal 
more.  But  hold  your  hand  over  a  cup  of  hot  water  for  a 
minute  or  two,  and  then,  by  merely  rubbing  with  the  fin- 
ger, you  will  bring  of  flakes  off  dirt  or  dirty  skin.  After 
a  vapor  bath  you  may  peel  your  whole  self  clean  in  this 
way.  What  I  mean  is,  that  by  simply  washing  or  spong- 
ing with  water  you  do  not  really  clean  your  skin.  Take  a 
rough  towel,  dip  one  corner  in  very  hot  water,  —  if  a  little 
spirit  be  added  to  it  it  will  be  more  effectual,  —  and  then 
rub  as  if  you  were  rubbing  the  towel  into  your  skin  with 
jour  fingers.  The  black  iiakes  which  will  come  off  will 
eonvince  you  that  you  were  not  clean  before,  however 
much  soap  and  water  you  have  used.  These  flakes  are 
what  require  removing.  And  you  can  really  keep  your- 
self cleaner  with  a  tumbler  of  hot  water  and  a  rough  towel 
and  rubbing,  than  with  a  whole  apparatus  of  bath  and 
soap  and  sponge,  without  rubbing.  It  is  quite  nonsense  to 
say  that  anybody  need  be  dirty.  Patients  have  been  kept 
as  clean  by  these  means  on  a  long  voyage,  when  a  basin 
full  of  water  could  not  be  aflbrded,  and  when  they  could 
not  be  moved  out  of  their  berths,  as  if  all  the  appurte- 
nances of  home  had  been  at  hand. 

Washing,  however,  with  a  large  quantity  of  water  lias 
quite  other  eftects  than  those  of  mere  cleanliness.  The 
skin  absorbs  the  water  and  becomes  softer  and  more  per- 
spirable. To  wash  with  soap  and  soft  water  is,  therefore, 
desirable  from  other  points  of  view  than  that  of  cleanli- 
ness. 

Xn.     CHATTERING  HOPES   AND   ADVICES. 

The  sick  man  to  his  advisers. 

"  ]My  advisers !  Their  name  is  legion.  *  *  * 
Somehow  or  other,  it  seems  a  provision  of  the  universal 
destinies,  that  every  man,  woman,  and  child  should  con- 
sider him,  her,  or  itself  privileged  especially  to  advise  me. 


CHATTERING  HOPES  AND  ADVICES.  73 

"Wliy  ?  That  is  precisely  what  I  want  to  know."  And 
this  is  what  I  have  to  say  to  them.  I  have  been  advised 
to  go  to  every  place  extant  in  and  out  of  England  —  to 
take  every  kind  of  exercise  by  every  kind  of  cart,  car- 
riage —  yes,  and  even  swing  (I)  and  dnmb-bell  (!)  in  exist- 
ence ;  to  imbibe  every  different  kind  of  stimulus  that  ever 
has  been  invented.  And  this  when  those  best  fitted  to 
know,  viz.,  medical  men,  after  long  und  close  attendance, 
}iad  declared  any  journey  out  of  the  question,  had  prohib- 
ited any  kind  of  motion  whatever,  had  closely  laid  down 
the  diet  and  drink.  What  would  my  advisers  say,  were 
they  the  medical  attendants,  and  I  the  patient  left  their 
advice,  and  took  the  casual  adviser's  ?  But  the  singularity 
in  Legion's  mind  is  this :  it  never  occurs  to  liim  that 
everybody  else  is  doing  the  same  tiling,  and  that  I  the  pa- 
tient must  perforce  say,  in  sheer  self-defence,  like  Rosalind, 
"  I  could  not  do  with  all." 

"  Chattering  Hopes  "  may  seem  an  odd  heading.  But  I 
really  believe  there  is  scarcely  a  gi'eater  worry  which  in- 
valids have  to  endure  than  the  incurable  hopes  of  their 
friends.  There  is  no  one  practice  against  which  I  can 
speak  more  strongly  from  actual  personal  experience,  wide 
and  long,  of  its  effects  during  sickness  observed  both  upon 
others  and  upon  myself.  I  would  appeal  most  seriously  to 
all  friends,  visitors,  and  attendants  of  the  sick  to  leave  off 
this  practice  of  attempting  to  "  cheer  "  the  sick  by  making 
light  of  their  danger  and  by  exaggerating  their  probabili- 
ties of  recovery. 

Far  more  now  than  formerly  does  the  medical  attendant 
tell  the  truth  to  the  sick  who  are  really  desirous  to  hear  it 
about  their  own  state. 

How  intense  is  the  folly,  then,  to  say  the  least  of  it,  of 
the  friend,  be  he  even  a  medical  man,  who  thinks  that  his 
opinion,  given  after  a  cursory  observation,  will  weigh  with 
the  patient,  against  the  opinion  of  the  medical  attendant, 
given,  perhaps,  after  years  of  observation,  after  using  every 
help  to  diagnosis  afforded  by  the  stethosco]>e,  the  exami- 
nation of  pulse,  tongue,  &c. ;  and  certainly  after  much  more 
observation  than  the  friend  can  possibly  liave  had. 

Supposing  the  ])atient  to  be  possessed  of  common  sense 

—  how  can  the  "favourable"  opinion,  if  it  is  to  be  called 

an   opinion  at  all,  of  the  casual  visitor  "cheer"  him, — 

when  different  from  that  of  the  experienced  attendant? 

7 


74  NOTES   ON   NURSING. 

Unquestionably  the  latter  may,  and  often  does,  turn  out 
to  be  ^Vrong.     But  which  is  most  likely  to  be  wrong? 

The  fact  is,  that  the  patient  *  is  not  "  cheered  "  at  all  by 
these  well-meaning,  most  tiresome  friends.  On  the  con- 
trary, he  is  depressed  and  wearied.  If,  on  the  one  hand, 
he  exerts  himself  to  tell  each  successive  member  of  this 
too  numerous  conspiracy,  w^hose  name  is  legion,  why  he 
does  not  think  as  they  do,  —  in  what  respect  he  is  worse, 
—  what  symptoms  exist  that  they  know  nothing  of,  —  lie 
is  fatigued  instead  of  "  cheered,"  and  his  attention  is  fixed 
uj^on  himself.  In  general,  patients  who  are  really  ill,  do 
not  want  to  talk  about  themselves.  Hypochondriacs  do, 
but  again  I  say  we  are  not  on  the  subject  of  hypochon- 
driacs. 

If,  on  the  other  hand,  and  w^hich  is  much  more  fi-e- 
quently  the  case,  the  patient  says  nothing,  but  the  Shake- 
spearian «0h!"  "Ah!"  "Go  to!"  and  '^n  good  sooth!" 
in  order  to  escape  from  the  conversation  about  himself  the 
sooner,  he  is  depressed  by  want  of  sympathy.  He  feels 
isolated  in  the  midst  of  friends.  He  feels  what  a  conven- 
ience it  would  be,  if  there  were  any  single  person  to  whom 

*  There  are,  of  course,  cases,  as  in  first  confinements,  when  an 
assurance  from  the  doctor  or  experienced  nurse  •to  the  frightened  suf- 
fering woman  that  there  is  nothing  unusual  in  her  case,  that  she  has 
nothing  to  fear  but  a  few  hours'  pain,  may  cheer  her  most  effectually. 
This  is  ad\'ice  of  quite  another  order.  It  is  the  advice  of  experience  to 
utter  inexperience.  But  the  advice  we  have  been  referring  to  is  the 
advice  of  inexperience  to  bitter  experience  ;  and,  in  general,  amounts  to 
nothing  more  than  this,  that  you  think  I  shall  recover  from  consump- 
tion because  somebody  knows  somebody  somewhere  who  has  recovered 
from  fever. 

I  have  heard  a  doctor  condemned  whose  patient  did  not,  alas ! 
recover,  because  another  doctor's  patient  of  a  different  sex,  of  a  different 
age,  recovered  from  a  different  disease,  in  a  different  place.  Yes,  this  is 
really  true.  If  people  who  make  these  comparisons  did  but  know 
(only  they  do  not  care  to  know),  the  care  and  preciseness  Avith  v/hich 
such  comparisons  require  to  be  made,  (and  are  made,)  in  order  to  be 
of  any  value  Avhatever,  they  would  spare  their  tongues.  In  comparing 
the  deaths  of  one  hospital  with  those  of  another,  any  statistics  are  justly 
considered  absolutely  valueless  which  do  not  give  the  ages,  the  sexes, 
and  the  diseases  of  all  the  cases.  It  does  not  seem  necessary  to  mention 
this.  It  does  not  seem  necessary  to  say  that  there  can  be  no  compari- 
son between  old  men  with  dropsies  and  young  women  with  consump- 
tions. Yet  the  cleverest  men  and  the  cleverest  women  are  often  lieard 
making  such  comparisons,  ignoring  entirely  sex,  age,  disease,  place  — 
in  fact,  all  the  conditions  essential  to  the  question.  It  is  the  merest 
gossip. 


CHATTERING   HOPES   AND   ADVICES.  75 

he  could  speak  simply  and  openly,  without  pulling  the  string 
upon  himself  of  this  shower-bath  of  silly  hopes  and  en- 
couragements; to  whom  he  could  express  liis  wishes  and 
directions  without  that  pei-son  persisting  in  saying  "  I  ho])e 
that  it  will  please  God  yet  to  give  you  twenty  years,"  or, 
"  You  have  a  long  life  of  activity  before  you."  How  often 
we  see  at  the  end  of  biographies  or  of  cases  recorded  in 
medical  papers,  "  after  a  long  illness  A.  died  rather  sud- 
denly," or,  "  unexpectedly  both  to  himself  and  to  others." 
"Unexpectedly"  to  others,  perhaps,  who  did  not  see,  be- 
cause they  did  not  look;  but  by  no  means  "unexpectedly 
to  himself,"  as  I  feel  entitled  to  believe,  both  from  the  in- 
ternal evidence  in  such  stories,  and  from  watching  similar 
cases :  there  was  every  reason  to  expect  that  A.  would  die, 
and  he  knew  it;  but  he  found  it  useless  to  insist  upon  his 
own  knowledge  to  his  friends. 

In  these  remarks  I  am  alluding  neither  to  acute  cases 
which  terminate  rapidly  nor  to  "  nervous  "  cases. 

By  the  first  much  interest  in  their  own  danger  is  very 
rarely  felt.  In  writings  of  fiction,  whether  novels  or  biog- 
raphies, these  death-beds  are  generally  depicted  as  almost 
seraphic  in  lucidity  of  intelhgence.  Sadly  large  has  been 
my  experience  in  death-beds,  and  I  can  only  say  that  I 
have  seldom  or  never  seen  such.  Indifference,  excepting 
with  regard  to  bodily  suffering,  or  to  some  duty  the  dying 
man  desires  to  perform,  is  the  far  more  usual  state. 

The  "nervous  case,"  on  the  other  hand,  delights  in  fig- 
uring to  himself  and  others  a  fictitious  danger. 

But  the  long  chronic  case,  who  knows  too  well  himself, 
and  who  has  been  told  by  his  physician  that  he  wdll  never 
enter  active  life  again,  who  feels  that  every  month  he  has 
to  give  up  something  he  could  do  the  month  before  —  oh ! 
spare  such  sufferers  your  chattering  hopes.  You  do  not 
know  how  you  worry  and  weary  them.  Such  real  suffer- 
ers cannot  bear  to  talk  of  themselves,  still  less  to  hope  for 
what  they  cannot  at  all  expect. 

So  also  as  to  all  the  advice  showered  so  profusely  upon 
such  sick,  to  leave  off  some  occupation,  to  try  some  other 
doctor,  some  other  house,  climate,  pill,  powder,  or  specific ; 
I  say  nothing  of  the  inconsistency  —  for  these  advisers  are 
sure  to  be  the  same  persons  who  exhorted  the  sick  man 
not  to  beUeve  his  own  doctor's  prognostics,  because  "  doc- 
tors  are   always   mistaken,"   but   to   believe   some  other 


76  NOTES   ON   NURSING. 

doctor,  because  "  this  doctor  is  always  right."  Sure  also 
are  these  advisers  to  be  the  persons  to  bring  the  sick  man 
fresh  occupation,  while  exhorting  him  to  leave  his  own. 

Wonderful  is  the  foce  with  which  friends,  lay  and  medi- 
cal, will  come  in  and  wony  the  patient  with  recommenda- 
tions to  do  something  or  other,  having  just  as  little  knowl- 
edge as  to  its  being  feasible,  or  even  safe  for  him,  as  if 
they  were  to  recommend  a  man  to  take  exercise,  not 
knowing  he  had  broken  his  leg.  What  would  the  friend 
say,  if  he  were  the  medical  attendant,  and  if  the  patient, 
because  some  other  Mend  had  come  in,  because  somebody, 
anybody,  nobody,  had  recommended  something,  anything, 
nothing,  were  to  disregard  his  orders,  and  take  that  other 
body's  recommendation  ?     But  people  never  think  of  this. 

A  celebrated  historical  personage  has  related  the  com- 
monplaces which,  when  on  the  eve  of  executing  a  remark- 
able resolution,  were  showered  in  nearly  the  same  words 
by  every  one  around  successively  for  a  period  of  six 
nionths.  To  these  the  personage  states  that  it  was  found 
least  trouble  always  to  reply  the  same  thing,  viz.,  that  it 
could  not  be  supj^osed  that  such  a  resolution  had  been 
taken  without  sufficient  previous  consideration.  To  pa- 
tients enduring  every  day  for  years  from  every  friend  or 
acquaintance,  either  by  letter  or  m^ya  voce,  some  torment 
of  this  kind,  I  would  suggest  the  same  answer.  It  would 
indeed  be  spared,  if  such  friends  and  acquaintances  would 
but  consider  for  one  moment,  that  it  is  probable  the  pa- 
tient has  heard  sueh  advice  at  least  fifty  times  before,  and 
that,  had  it  been  practicable,  it  would  have  been  practised 
long  ago.  But  of  such  consideration  there  appear  to  be 
no  chance.  Strange,  though  true,  that  people  should  be 
just  the  same  in  these  things  as  they  were  a  few  hundred 
years  ago ! 

To  me  these  commonplaces,  leaving  their  smear  upon 
the  cheerful,  single-hearted,  constant  devotion  to  duty, 
which  is  so  often  seen  in  the  decline  of  such  sufferers,  re- 
call the  slimy  tmil  left  by  the  snail  on  the  sunny  southern 
garden-wall  loaded  with  fruit. 

No  mockery  in  the  world  is  so  hollow  as  the  advice 
showered  upon  the  sick.  It  is  of  no  use  for  the  sick  to 
say  anything,  for  what  the  adviser  wants  is,  not  to  know 
the  truth  about  the  state  of  the  patient,  but  to  turn  what- 
ever the  sick  may  say  to  the  support  of  his  own  argument, 


CHATTERING  HOPES  AND  ADVICES.  77 

get  forth,  it  must  be  repeated,  without  any  inquiry  what- 
ever into  the  jD^tient's  real  condition.  "  But  it  would  be 
impertinent  or  indecent  in  me  to  make  such  an  inquiry," 
says  the  adviser.  True  ;  and  how  much  more  impertinent 
is  it  to  give  your  advice  when  you  can  know  nothing  about 
the  truth,  and  admit  you  could  not  inquire  into  it. 

To  nurses  I  say  —  these  are  the  visitors  Avho  do  your 
patient  harm.  When  you  hear  him  told:  —  1.  That  he 
has  nothing  the  matter  with  him,  and  that  he  wants  cheer- 
ing. 2.  That  he  is  committing  suicide,  and  that  he  wants 
preventing.  3.  That  he  is  the  tool  of  somebody  who 
makes  use  of  him  for  a  purpose.  4.  That  he  will  listen  to 
nobody,  but  is  obstinately  bent  upon  his  own  way ;  and  5. 
That  he  ought  to  be  called  to  a  sense  of  duty,  and  is  fly- 
ing in  the  face  of  Providence ;  —  then  know  that  your  pa- 
tient is  receiving  all  the  injury  that  he  can  receive  from  a 
visitor. 

How  little  the  real  sufferings  of  illness  are  known  or 
understood.  How  little  does  any  one  in  good  health  fancy 
him  or  even  Aerself  into  the  life  of  a  sick  person. 

Do,  you  who  are  about  the  sick  or  who  visit  the  sick,  try 
and  give  them  pleasure,  remember  to  tell  them  what  will 
do  so.  How  often  in  such  visits  the  sick  person  has  to  do 
the  whole  conversation,  exerting  his  own  imagination  and 
memory,  while  you  would  take  the  visitor,  absorbed  in-his 
own  anxieties,  making  no  effort  of  memory  or  imagination, 
for  the  sick  person.  "  Oh !  my  dear,  I  have  so  much  to 
think  of,  I  really  quite  forgot  to  tell  him  that ;  besides,  I 
thought  he  would  know  it,"  says  the  visitor  to  another 
friend.  How  could  "he  know  it?"  Depend  upon  it,  the 
people  who  say  this  are  really  those  who  have  little  "  to 
think  of"  There  are  many  burthened  with  business  who 
always  manage  to  keep  a  pigeon-hole  in  their  minds,  full 
of  things  to  tell  the  "  invalid." 

I  do  not  say,  don't  tell  him  your  anxieties  — I  believe  it 
is  good  for  him  and  good  for  you  too ;  but  if  you  tell  him 
what  is  anxious,  surely  you  can  remember  to  tell  him  what 
is  pleasant  too. 

A  sick  person  does  so  enjoy  hearing  good  news:  —  for 

instance,  of  a  love  and   courtship,  while  in  progress  to  a 

good  ending.     If  you  tell  him   only  when   the  marriage 

takes  place,  he  loses  half  the  pleasure,  which  God  knows 

7* 


78  KOTES  ON  NUriSIKG. 

he  lias  little  cnoiigli  of;  and  ten  to  one  but  you  have  told 
him  of  some  love-making  with  a  had  ending. 

A  sick  person  also  intensely  enjoys  hearing  of  any  m«- 
terial  good,  any  positive  or  practical  success  of  the  light. 
He  has  so  much  of  books  and  fiction,  of  principles,  and 
precepts,  and  theories ;  do,  instead  of  advising  him  with 
advice  he  has  heard  at  least  fifty  times  before,  tell  him  of 
one  benevolent  act  which  has  really  succeeded  practically, 
—  it  is  like  a  day's  health  to  him.* 

You  have  no  idea  what  the  craving  of  sick  w^ith  undi- 
minished power  of  thinking,  but  little  power  of  doing,  is 
to  hear  of  good  j^ractical  action,  when  they  can  no  longer 
partake  in  it. 

Do  observe  these  things  with  the  sick.  Do  remember 
how  their  life  is  to  them  disappointed  and  incomplete. 
You  see  them  lying  there  with  miserable  disappointments, 
from  which  they  can  have  no  escape  but  death,  and  you 
can't  remember  to  tell  them  of  what  would  give  them  so 
much  pleasure,  or  at  least  an  hour's  variety. 

They  don't  w%ant  you  to  be  lachrymose  and  whining  with 
them; "they  like  you  to  be  fresh  and  active  and  interested, 
but  they  cannot  bear  absence  of  mind,  and  they  are  so 
tired  of  the  advice  and  preaching  they  receive  from  every- 
body, no  matter  whom  it  is,  they  see. 

TKere  is  no  better  society  than  babies  and  sick  pe(tj)le 
for  one  another.  Of  course  you  must  manage  this  so  that 
neither  shall  suffer  from  it,  which  is  perfectly  possible.  If 
you  think  the  "  air  of  the  sick  room  "  bad  for  the  baby,  wliy 
It  is  bad  for  the  invalid  too,  and  therefore  you  will  of  course 
correct  it  for  both.  It  freshens  up  a  sick  person's  whole 
mental  atmosphere  to  see  "  the  baby."  And  a  very  young 
child,  if  unspoiled,  w^ill  generally  adapt  itself  wonderfully 
to  the  ways  of  a  sick  person,  if  the  time  they  spend  together 
is  not  too  long. 

If  you  knew  how  unreasonably  sick  people  suifer  from 
reasonable  causes  of  distress,  you  would  take  more  pains 
about  all  these  things.  An  infant  laid  upon  the  sick  bed 
will  do  the  sick  person,  thus  suffering,  more  good  than  all 

*  A  small  pet  animal  is  often  an  excellent  companion  for  the  sick, 
for  long  chronic  cases  especially.  A  pet  bird  in  a  cage  is  sometimes 
the  only  pleasure  of  an  invalid  confined  for  years  to  the  same  room. 
If  he  can  feed  and  clean  the  animal  himself,  he  oiight  always  to  be 
encouraoed  to  do  so. 


OBSERVATION   OP   THE   SICK.  79 

your  logic.  A  piece  of  good  news  will  do  the  same.  Per- 
haj^s  you  are  afraid  of  "disturbing"  him.  You  say  there 
is  no  comfort  for  his  present  cause  of  affliction.  It  is  per- 
fectly reasonable.  The  distinction  is  this  :  if  he  is  obliged 
to  act,  do  not  "disturb"  him  with  another  subject  of 
thought  just  yet;  help  him  to  do  what  he  wants  to  do; 
but,  if  he  has  done  this,  or  if  nothing  can  be  done,  then 
"  disturb  "  him  by  all  means.  You  will  relieve,  more  effect- 
ually, unreasonable  suffering  from  reasonable  causes  by 
telling  him  "  the  news,"  showing  him  "  the  baby,"  or  giv- 
ing him  something  new  to  think  of  or  to  look  at  than  by 
all  the  logic  in  the  world. 

It  has  been  very  justly  said  that  the  sick  are  like  chil- 
dren in  this,  that  there  is  no  proportion  in  events  to  them. 
Now  it  is  your  business  a^  their  visitor  to  restore  this  right 
proportion  for  them  —  to  show  them  what  the  rest  of  the 
world  is  doing.  How  can  they  find  it  out  otherwise  ? 
You  will  find  them  fir  more  open  to  conviction  than  chil- 
dren in  this.  And  you  will  find  that  their  unreasonable 
intensity  of  suffering  from  unkindness,  from  want  of  sym- 
pathy, &c.,  will  disappear  Avith  their  freshened  interest  in 
the  big  workfs  events.  But  then  you  must  be  able  to  give 
them  real  interests,  not  gossip. 

Note.  —  There  are  two  classes  of  patients  which  are  unfortunately 
becoming  more  common  every  day,  e.^pecially  among  women  of  the 
richer  orders,  to  whom  all  these  remarks  are  preeminently  inapplicable. 

1.  Those  who  make  health  an  excuse  for  doing  nothing,  and  at  the 
same  time  allege  that  the  being  able  to  do  nothing  is  their  only  grief. 

2.  Those  who  have  brought  upon  themselves  ill-health  by  over  pursuit 
of  amusement,  which  they  and  their  friends  have  most  unhappily  called 
intellectual  activity.  I  scarcely  know  a  greater  injury  that  can  be 
inflicted  than  the  advice  too  often  given  to  the  first  class  to  "  vegetate  " 
—  or  than  the  admiration  too  often  bestowed  on  the  latter  class  for 
"  pluck." 


Xni.     OBSERVATION   OF   THE    SICK. 

There  is  no  more  silly  or  universal  question  scarcely 
asked  than  this,  "  Is  he  better  ?  "  Ask  it  of  the  medical 
attendant,  if  you  please.  But  of  whom  else,  if  you  wish 
for  a  real  answer  to  your  question,  would  you  ask  it?  Cer- 
tainly not  of  the  casual  visitor;  certainly  not  of  the  nurse, 
while  the  nurse's  obseiwation  is  so  little  exercised  as  it  is 


so  NOTES  ON  t^vmtm. 

now*  What  you  want  are  fact;?,  not  opinions ;  for  who  can 
have  any  opinion  of  any  vahxe  a»  to  whether  the  patient  is 
better  or  wor&e,  excepting  the  constant  medical  attendant, 
or  the  really  observing  nurse  ? 

The  most  important  practical  lesson  that  can  be  given 
to  nur»es  is  to  teach  them  what  to  obsen^e  —  how  to  ob- 
geiwe — what  symptoms  indicate  improvement  —  what  the 
reverse — -which  are  of  importance  —  which  are  of  none 
—  which  are  the  evidence  of  neglect  —  and  of  what  kind 
of  neglect. 

All  this  is  what  ought  to  make  pait,  and  an  essential 
part,  of  the  training  of  every  nurse.  At  present,  how  few 
there  are,  either  professional  or  unprofessional,  who  really 
know  at  all  whether  any  sick  person  they  may  be  with  is 
better  or  worse. 

The  vagueness  and  looseness  of  the  infoiination  one  re- 
ceives in  answer  to  that  much  abused  question,  "Is  he 
better  ?  "  would  be  ludicrous,  if  it  were  not  painful.  The 
only  sensible  answer  (in  the  present  state  of  knowledge 
about  sickness)  Tvould  be  "  How  can  I  know  ?  I  cannot  tell 
how  he  was  when  I  was  not  with  him." 

I  can  record  but  a  very  few  ^^pecimens  of  the  answers  * 

*  It  is  a  much  more  difficult  thing  to  speak  the  truth  than  people 
commonly  imagine.  There  is  the  want  of  observation  simple,  and  the 
ivant  of  observation  compoimd,  compounded,  that  is,  with  the  imagina- 
tive faculty.  Both  may  equally  intend  to  speak  the  truth.  The 
information  of  the  first  is  simply  defective.  That  of  the  second  is  much 
more  dangerous.  The  first  gives,  in  answer  to  a  question  asked  about 
a  thing  that  has  been  before  his  eyes  perhaps  for  years,  information 
exceedingly  imperfect,  or  says,  he  does  not  know.  He  has  never 
observed.     And  people  simply  think  him  stupid. 

The  second  has  observed  just  as  little,  but  imagination  immediately 
steps  in,  and  he  describes  the  whole  thing  from  imagination  merely, 
being  perfectly  convinced  all  the  while  that  he  has  seen  or  heard  it ;  or 
he  will  repeat  a  whole  conversation,  as  if  it  were  information  which  had 
been  addressed  to  him  ;  whereas  it  is  merely  what  he  has  himself  said 
to  somebody  else.  This  is  the  commonest  of  all.  These  people  do  not 
even  observe  that  they  have  7iot  observed,  nor  remember  that  they  have 
forgotten. 

Courts  of  justice  seem  to  think  that  anybody  can  speak  "the  whole 
truth,  and  nothing  but  the  truth,"  if  he  does  but  intend  it.  It  requires 
many  faculties  combined  of  observation  and  memory  to  speak  "  the 
whole  truth,"  and  to  say  "  nothing  but  the  truth." 

"I  knows  I  fibs  dreadful;  but  believe  me.  Miss,  I  never  finds  out  I 
have  fibbed  until  they  tells  me  so,"  was  a  remark  actually  made.  It  is 
also  one  of  much  more  extended  application  than  most  people  have  the 
least  idea  of. 


OBSERVATION  OF  THE  SICK.  81 

which  I  have  heard  made  by  friends  and  nurses,  and  ac- 
cepted by  physicians  and  surgeons  at  the  very  bed-side  of 
the  patient,  who  could  have  contradicted  every  word,  but 
did  not  —  sometimes  from  amiability,  often  from  shyness, 
oftenest  from  languor ! 

"  How  often  have  the  bowels  acted,  nurse  ?  "  "  Once,  sir." 
This  generally  means  that  the  utensil  has  been  emptied 
once,  it  having  been  used  perhaps  seven  or  eight  times. 

"I)o  you  think  the  patient  is  much  weaker  than  he  was 
six  weeks  ago  ?  "  "  Oh  no,  sir ;  you  know  it  is  very  long 
since  he  has  been  up  and  dressed,  and  he  can  get  across 
the  room  now."  This  means  that  the  nurse  has  not  ob- 
seiwed  that  whereas  six  weeks  ago  he  sat  up  and  occupied 
himself  in  bed,  he  now  lies  still  doing  nothing ;  that  al- 
though he  can  "get  across  the  room,"  he  cannot  stand  for 
five  seconds. 

Another  patient  who  is  eating  well,  recovering  steadily, 
although  slowly,  from  fever,  but  cannot  Avalk  or  stand,  is 
represented  to  the  doctor  as  making  no  progress  at  all. 

Questions,  too,  as  asked  now  (but  too  generally)  of  or 
about  patients,  would  obtain  no  information  at  all  about 
them,  even  if  the  person  asked  of  had  every  information 
to  give.  The  question  is  generally  a  leading  question ; 
and  it  is  singular  that  people  never  think  what  must  be 
the  answer  to  this  question  before  they  ask  it :  for  instance, 
"  Has  he  had  a  good  night  ?  "  Now,  one  patient  will  think 
he  has  had  a  bad  night  if  he  has  not  slept  ten  hours  with- 
out waking.  Another  does  not  think  he  has  had  a  bad 
night  if  he  has  had  intervals  of  dozing  occasionally.  The 
same  answer  has  actually  been  given  as  regarded  two  pa- 


Concurrence  of  testimony,  which  is  so  often  adduced  as  final  proof, 
may  prove  nothing  more,  as  is  well,  known  to  those  accustomed  to  deal 
with  the  unobservant  imaginative,  than  that  one  person  has  told  his 
story  a  great  many  times. 

I  have  heard  thirteen  persons  •♦concur"  in  declaring  that  a  four- 
teenth, who  had  never  left  his  bed,  went  to  a  distant  chapel  every  morn- 
ing at  seven  o'clock. 

I  have  heard  persons  in  perfect  good  faith  declare,  that  a  man  came 
to  dine  every  day  at  the  house  where  they  lived,  who  had  never  dined 
there  once  ;  that  a  person  had  never  taken  the  saci-ament,  by  whose  side 
they  liad  twice  at  least  knelt  at  Communion  ;  that  but  one  meal  a  day 
came  out  of  a  hospital  kitchen,  which  for  six  weeks  they  had  seen  pro- 
vide from  three  to  five  and  six  meals  a  day.  Such  instances  might  be 
multiplied  ad  infiuUuin  if  necessary. 


82  NOTES   ON  NURSING. 

tients  —  one  who  had  been  entirely  sleepless  for  five  thnea 
twenty-four  hours,  and  died  of  it,  and  another  who  had 
not  slept  the  sleep  of  a  regular  night,  without  waking. 
Why  cannot  the   question   be   asked,  How  many  hours' 

sleep  has had  ?  and  at  what  hours,  of  the  night  ?  * 

"I  have  never  closed  ray  eyes  all  night,"  an  answer  as  fre- 
quently made  when  the  speaker  has  had  several  hours' 
sleep  as  when  he  has  had  none,  would  then  be  less  often 
said.  Lies,  intentional  and  unintentional,  are  much  sel- 
domer  told  in  answer  to  precise  than  to  leading  questions. 

Another  frequent  error  is  to  inquire  whether  one  cause 
remains,  and  not  whether  the  effect  which  may  be  j)ro- 
duced  by  a  great  many  different  causes,  7iot  inquired  after, 
remains.  As  when  it  is  asked,  whether  there  was  noise  in 
the  street  last  night ;  and  if  there  were  not,  the  patient  is 
reported,  without  more  ado,  to  have  had  a  good  night. 
Patients  are  completely  taken  aback  by  these  kinds  of 
leading  questions,  and  give  only  the  exact  amount  of  in- 
formation asked  for,  even  when  they  know  it  to  be  com- 
pletely misleading.  The  shyness  of  patients  is  seldom  al- 
lowed for. 

How  few  there  are  who,  by  five  or  six  pointed  questions, 
can  elicit  the  whole  case,  and  get  accurately  to  know  and 
to  be  able  to  report  ivhere  the  patient  is. 

I  knew  a  very  clever  physician,  of  large  dispensary  and 
hospital  practice,  who  invariably  began  his  examination  of 
each  patient  with  "Put  your  linger  where  you  be  Ijad." 
That  man  would  never- waste  his  time  with  collecting  in- 
accurate information  from  nurse  or  patient.  Leading  ques- 
tions always  collect  inaccurate  information. 

At  a  recent  celebrated  trial,  the  following  leading  ques- 
tion was  put  successively  to  nine  distinguished  medical 
men.  "  Can  you  attribute  these  symptoms  to  anything 
else  but  poison  ? "  And  out  of  the  nine,  eight  answered 
"  No ! "  without  any  qualification  whatever.     It  appeared, 


*  This  is  important,  because  on  this  depends  Avhat  the  remedy  will 
be.  If  a  patient  sleeps  two  or  three  hours  early  in  the  night,  and  then 
does  not  sleep  again  at  all,  ten  to  one  it  is  not  a  narcotic  he  wants,  but 
food  or  stimulus,  or  perhaps  only  warmth.  If,  on  the  other  hand,  he 
is  restless  and  awake  all  night,  and  is  drowsy  in  the  morning,  he  proba- 
bly wants  sedatives,  either  quiet,  coolness,  or  medicine,  a  lighter  diet, 
or  all  four.  Now  the  doctor  should  be  told  this,  or  how  can  he  judge 
what  to  give  r 


OBSERVATION  OP  THE  SICK.  83 

upon  cross-examination :  —  1.  That  none  of  them  had 
ever  seen  a  case  of  the  kind  of  poisoning  supposed.  2. 
That  none  of  them  had  ever  seen  a  case  of  the  kind  of  dis- 
ease to  which  the  death,  if  not  to  poison,  was  attributa- 
ble. 3.  That  none  of  them  were  even  aware  of  the  main 
fact  of  the  disease  and  condition  to  which  the  death  was 
attributable. 

Surely  nothing  stronger  can  be  adduced  to  prove  what 
use  leading  questions  are  of,  and  what  they  lead  to. 

I  had  rather  not  say  how  many  instances  I  have  known, 
w^here,  owing  to  this  system  of  leading  questions,  the  pa- 
tient has  died,  and  the  attendants  have  been  actually  un- 
aware of  the  principal  feature  of  the  case. 

It  is  useless  to  go  through  all  the  particulars,  besides 
sleep,  in  which  people  have  a  peculiar  talent  for  gleaning 
inaccurate  information.  As  to  food,  for  instance,  I  often 
think  that  most  common  question,  How^  is  your  appetite  ?  can 
only  be  put  because  the  questioner  believes  the  questioned 
has  really  nothing  the  matter  with  him,  which  is  very  oft- 
en the  case.  But  where  there  is,  the  remark  holds  good 
which  has  been  made  about  sleep.  The  same  answer  will 
often  be  made  as  regards  a  patient  who  cannot  take  two 
ounces  of  solid  food  per  diem,  and  a  patient  who  does  not 
enjoy  five  meals  a  day  as  much  as  usual. 

Again,  the  question.  How  is  your  appetite  ?  is  often  put 
when  How  is  your  digestion  ?  is  the  question  meant.  No 
doubt  the  two  things  depend  on  one  another.  But  they 
are  quite  different.  Many  a  patient  can  eat,  if  you  can 
only  "  tempt  his  appetite."  The  fault  lies  in  your  not  hav- 
ing got  him  the  thing  he  fancies.  But  many  another  pa- 
tient does  not  care  between  grapes  and  turnips  —  every 
thing  is  equally  distasteful  to  him.  He  would  try  to  eat 
anything  which  would  do  him  good ;  but  everything 
"makes  him  worse."  The  fault  here  generally  lies  in  the 
cooking.  It  is  not  his  "  appetite  "  which  requires  "  tempt- 
ing," it  is  his  digestion  which  requires  sparing.  And  good 
sick  cookery  will  save  the  digestion  half  its  work. 

There  may  be  four  different  causes,  any  one  of  which 
will  produce  the  same  result,  viz.,  the  patient  slowly  starv- 
ing to  death  from  want  of  nutrition : 

1.  Defect  in  cooking ; 

2.  Defect  in  choice  of  diet ; 

3.  Defect  in  choice  of  hours  for  taking  diet ; 


84  NOTES   ON  NURSING. 

4.  Defect  of  appetite  in  patient. 
Yet  all  these  are  generally  comprehended  in  the  one  sweep- 
ing assertion  that  the  patient  has  "  no  appetite." 

Surely  many  lives  might  be  saved  by  drawing  closer  dis- 
tinction ;  for  the  remedies  are  as  diverse  as  the  causes. 
The  remedy  for  the  first  is  to  cook  better  ;  for  the  second, 
to  choose  other  articles  of  diet ;  for  the  third,  to  watch  for 
the  hours  when  the  patient  is  in  want  of  food;  for  the 
fourth,  to  show  him  what  he  likes  and  sometimes  unex- 
pectedly. But  no  one  of  these  remedies  will  do  for  any 
other  of  the  defects  not  corresponding  with  it. 

I  cannot  too  often  repeat  that  patients  are  generally 
either  too  languid  to  observe  these  things,  or  too  shy  to 
speak  about  them ;  nor  is  it  well  that  they  should  be  made 
to  observe  them,  it  fixes  their  attention  upon  themselves. 

Again,  I  say,  what  is  the  nurse  or  friend  there  for  except 
to  take  note  of  these  things,  instead  of  the  patient  domg 
so?* 

Again,  the  question  is  sometimes  put.  Is  there  diarrhcea  ? 
And  the  answer  will  be  the  same,  whether  it  is  just  mer- 
ging into  cholera,  whether  it  is  a  trifling  degree  brought  on 
by  some  trifling  indiscretion,  which  will  cease  the  moment 
the  cause  is  removed,  or  whether  there  is  no  diarrhoea  at 
all  but  simply  relaxed  bowels. 

It  is  useless  to  multiply  instances  of  this  kind.  As  long 
as  observation  is  so  little  cultivated  as  it  is  now,  I  do  be- 
lieve that  it  is  better  for  the  physician  7iot  to  see  the  friends 
of  the  patient  at  all.  They  will  oftener  mislead  him  than 
not.  And  as  often  by  making  the  patient  out  worse  as 
better  than  he  really  is. 

In  the  case  of  infants,  everything  must  depend  upon  the 
accurate  observation  of  the  nurse  or  mother  who  has  to 
report.  And  how  seldom  is  this  condition  of  accuracy 
fulfilled. 

A  celebrated  man,  though  celebrated  only  for  fooUsh 

*  It  is  commonly  supposed  that  the  nurse  is  there  to  spare  the  patient 
from  making  physical  exertion  for  himself —  I  would  rather  say  that  she 
ought  to  be  there  to  spare  him  from  taking  thought  for  himself.  And 
I  am  quite  sure,  that  if  the  patient  were  spared  all  thought  for  himself, 
and  7iot  spared  all  physical  exertion,  he  would  be  intinitely  the  gamer. 
The  reverse  is  generally  the  case  in  the  private  house.  In  the  hospital 
it  is  the  relief  from  all  anxiety,  afforded  by  the  rules  of  a  well-regulated 
institution,  which  has  often  such  a  beneticial  etiect  upon  the  patient. 


OBSERVATION    OF   THE   SICK.  85 

things,  has  told  us  that  one  of  his  main  objects  in  the  edu- 
cation of  his  son,  was  to  give  hiin  a  ready  habit  of  accurate 
observation,  a  certainty  of  perception,  and  that  for  this  pur- 
pose one  of  his  means  was  a  month's  course  as  follows :  — 
he  took  the  boy  rapidly  past  a  toy-shop ;  the  father  and  son 
then  described  to  each  other  as  many  of  the  objects  as 
they  could,  which  they  had  seen  in  passing  the  windows, 
noting  them  down  with  pencil  and  paper,  and  returning 
afterwards  to  verify  their  own  accuracy.  The  boy  always 
succeeded  best,  e.  g.^  if  the  father  described  30  objects,  the 
boy  did  40,  and  scarcely  ever  made  a  mistake. 

I  have  often  thought  how  wise  a  piece  of  education 
this  would  be  for  much  higher  objects ;  and  in  our  calling 
of  nurses  the  thing  itself  is  essential.  For  it  may  safely 
be  said,  not  that  the  habit  of  ready  and  correct  observa- 
tion will  by  itself  make  us  useful  nurses,  but  that  without 
it  we  shall  be  useless  with  all  our  devotion. 

I  have  known  a  nurse  in  charge  of  a  set  of  wards,  who 
not  only  carried  in  her  head  all  the  little  varieties  in  the 
diets  which  each  patient  was  allowed  to  fix  for  himself,  but 
also  exactly  what  each  patient  had  taken  during  each  day. 
J  have  known  another  nurse  in  charge  of  one  single  pa- 
tient, who  took  away  his  meals  day  after  day  all  but  un- 
touched, and  never  knew  it. 

If  you  find  it  helps  you  to  note  down  such  things  on  a 
bit  of  paper,  in  pencil,  by  all  means  do  so.  I  think.it  more 
often  lames  than  strengthens  the  memory  and  observation. 
But  if  you  cannot  get  the  habit  of  observation  one  way  or 
other,  you  had  better  give  up  the  being  a  nurse,  for  it  is  not 
your  calhng,  however  kind  and  anxious  you  may  be. 

Surely  you  can  learn  at  least  to  judge  with  the  eye  how 
much  an  oz.  of  solid  food  is,  how  much  an  oz.  of  liquid. 
You  will  find  this  helps  your  observation  and  memory  very 
much ;  you  will  then  say  to  yourself,  "  A.  took  about  an  oz. 
of  his  meat  to-day ; "  "  B.  took  three  times  in  24  hours 
about  \  pint  of  beef  tea  ; "  instead  of  saying  "  B.  has  taken 
nothing  all  day,"  or  "  I  gave  A.  his  dinner  as  usual." 

I  have  known  several  of  our  real  old-fashioned  hospital 
"sisters,"  who  could,  as  accurately  as  a  measuring  glass, 
measure  out  all  their  patients'  wine  and  medicine  by  the 
eye,  and  never  be  wrong.  I  do  not  recommend  this ;  one 
must  be  very  sure  of  one's  self  to  do  it.  I  only  mention  it, 
because  if  a  nurse  can  by  practice  measure  medicine  by  the 


86  NOTES  ON  NURSING. 

eye,  surely  she  is  no  nurse  who  cannot  measure  by  the  eye 
about  liow  much  food  (in  oz.)  her  patient  has  taken*  In  hos- 
pitals those  who  cut  up  the  diets  give  with  quite  sufficient 
accuracy,  to  each  patient,  his  12  oz.  or  his  6  oz.  of  meat 
without  weighing.  Yet  a  nurse  will  often  have  patients 
loathing  all  food  and  incapable  of  any  will  to  get  well,  who 
just  tumble  over  the  contents  of  the  plate  or  dip  the  spoon 
in  the  cup  to  deceive  the  nurse,  and  she  Avill  take  it  away 
without  ever  seeing  that  there  is  just  the  same  quantity  of 

*  It  may  be  too  broad  an  assertion,  and  it  certainly  sounds  like  a  para- 
dox. But  I  think  that  in  no  country  are  women  to  be  found  so  deficient 
in  ready  and  sound  observation  as  in  England,  -while  peculiarly  capable 
of  being  trained  to  it.  The  French  or  Irish  woman  is  too  quick  of  per- 
ception to  be  so  sound  an  observer  —  the  Teuton  is  too  slow  to  be  so 
ready  an  observer  as  the  English  woman  might  be.  Yet  English 
women  lay  themselves  open  to  the  charge  so  often  made  against  them 
by  men,  viz.,  that  they  are  not  to  be  trusted  in  handicrafts  to  which 
their  strength  is  quite  equal,  for  want  of  a  practised  and  steady  obser- 
vation. In  countries  where  women  (with  average  intelligence  certainly 
not  superior  to  that  of  English  women)  are  employed,  e.  g.,  in  dispen- 
sing, men  responsible  for  what  these  women  do  (not  theorizing  about 
man's  and  woman's  «' missions,")  have  stated  that  they  preferred  the 
service  of  women  to  that  of  men,  as  being  more  exact,  more  careful, 
and  incurring  fewer  mistakes  of  inadvertence. 

Now  certainly  English  women  are  peculiarly  capable  of  attaining  to 
this. 

I  remember  when  a  child,  hearing  the  story  of  an  accident,  related 
by  some  one  who  sent  two  girls  to  fetch  a  "bottle  of  salvolatile  from 
her  room;  "  '«  Mary  could  not  stir,"  she  said,  "Fanny  ran  and  fetched 
a  bottle  that  was  not  salvolatile,  and  that  was  not  in  my  room." 

Now  this  sort  of  thing  pursues  every  one  through  life.  A  woman  is 
asked  to  fetch  a  large  new  bound  red  book,  lying  on  the  table  by  the 
window,  and  she  fetches  five  small  old  boarded  brown  books  lying  on 
the  shelf  by  the  fire.  And  this,  though  she  has  '<  put  that  room  to 
rights  "  every  day  for  a  month  perhaps,  and  must  have  observed  the 
books  every  day,  lying  in  the  same  places,  for  a  month,  if  she  had  any 
observation. 

Habitual  observation  is  the  more  necessary,  when  any  sudden  call 
arises.  If  "Fanny"  had  observed  "the  bottle  of  salvolatile"  in  "the 
aunt's  room,"  every  day  she  was  there,  she  would  more  probably  have 
found  it  when  it  was  suddenly  wanted. 

There  are  two  causes  for  these  mistakes  of  inadvertence.  1.  A  want 
of  ready  attention ;  only  part  of  the  request  is  heard  at  all.  2.  A 
want  of  the  habit  of  observation. 

To  a  nurse  I  would  add,  take  care  that  you  always  put  the  same 
things  in  the  sarne  places  ;  you  don't  know  how  suddenly  you  may  be 
called  on  some  day  to  find  something,  and  may  not  be  able  to  remem- 
ber in  your  haste  where  you  yourself  had  put  it,  if  your  memory  is  not 
there  always, 


OBSERVATION   OF   THE   SICK.  87 

food  as  when  she  brought  it,  and  she  will  tell  the  doctor, 
too,  that  the  patient  has  eaten  all  his  diets  as  usual,  when 
all  she  ought  to  have  meant  is  that  she  has  taken  away  his 
diets  as  usual. 

Now  what  kind  of  a  nurse  is  this. 

I  would  call  attention  to  something  else,  in  which  nurses 
frequently  fail  in  observation.  There  is  a  well-marked  dis- 
tinction between  the  excitable  and  what  I  will  call  the 
accumulative  temperament  in  jDatients.  One  will  blaze  up 
at  once,  under  any  shock  or  anxiety,  and  sleep  very  com- 
fortably after  it ;  another  will  seem  quite  calm  and  even 
torpid,  under  the  same  shock,  and  people  say,  "  He  hardly 
felt  it  at  all,"  yet  you  will  find  him  some  time  after  slowly 
sinking.  The  same  remark  applies  to  the  action  of  nar- 
cotics, of  aperients,  which,  in  the  one,  take  eftect  directly, 
in  the  other  not  perhaps  for  twenty-four  hours.  A  journey, 
a  visit,  an  unwonted  exertion,  will  aflTect  the  one  immedi- 
ately, but  he  recovers  after  it ;  the  other  bears  it  very  well 
at  the  time,  apparently,  and  dies  or  is  prostrated  for  life  by 
it.  People  often  say  how  difficult  the  excitable  tempera- 
ment is  to  manage.  I  say  how  difficult  is  tlie  accumulative 
temperament.  With  the  first  you  have  an  out-break  which 
you  could  anticipate,  and  it  is  all  over.  With  the  second 
you  never  know  Avhere  you  are  —  you  never  know  when 
the  consequences  are  over.  And  it  requires  your  closest 
observation  to  know  what  «re  the  consequences  of  what  — 
for  the  consequent  by  no  means  follows  immediately  upon 
the  antecedent  —  and  coarse  observation  is  utterly  at  fault. 

Almost  all  superstitions  are  owing  to  bad  observation,  to 
the  ^9<9s^  Aoc,  ergo  propter  hoc;  and  bad  observers  are 
almost  all  superstitious.  Farmers  used  to  attribute  disease 
among  cattle  to  witchcraft ;  weddings  have  been  attrib- 
uted to  seeing  one  magpie,  deaths  to  seeing  three ;  and  I 
have  heard  the  most  highly  educated  now-a-days  draw 
consequences  for  the  sick  closely  resembling  these. 

Another  remark :  although  there  is  unquestionably  a  phys- 
iognomy of  disease  as  well  as  of  health;  of  all  parts  of  the 
body,  the  face  is  perhaps  the  one  which  tells  the  least  to  the 
common  observer  or  the  casual  visitor.  Because,  of  all  parts 
of  the  body  it  is  the  one  most  exposed  to  other  influences, 
besides  health.  And  people  never,  or  scarcely  e^  er,  ob- 
serve enough  to  know  how  to  distinguish  between  the  ef- 
fect of  exposure,  of  robust  health,  of  a  tender  skin  of  a 


88  NOTES   ON  NURSING. 

tendency  to  congestion,  of  suffusion,  flushing,  or  many 
other  things.  Again,  the  face  is  often  the  hist  to  sliow 
emaciation.  I  should  say  that  the  hand  was  a  much  surer 
test  than  the  face,  both  as  to  flesh,  color,  circulation,  &c., 
&c.  It  is  true  that  there  are  some  diseases  which  are  only 
betrayed  at  all  by  something  in  the  face,  e.  g.^  the  eye  or 
the  tongue,  as  great  irritability  of  brain  by  the  appearance 
of  the  pupil  of  the  eye.  But  we  are  talking  of  casual, 
not  minute,  observation.  And  few  minute  observers  will 
hesitate  to  say  that  far  more  untruth  than  truth  is  con- 
veyed by  the  oft  repeated  words,  He  looks  well,  or  ill,  or 
better  or  worse. 

Wonderful  is  the  way  in  which  people  will  go  upon  the 
slightest  observation,  or  often  upon  no  observation  at  all, 
or  upon  some  saic^  which  the  world's  experience,  if  it  had 
any,  would  have  pronounced  utterly  false  long  ago 

I  have  known  patients  dying  of  sheer  pain,  exhaustion, 
and  want  of  sleep,  from  one  of  the  most  lingering  and 
painful  diseases  known,  preserve,  till  within  a  few  days  of 
death,  not  only  the  healthy  color  of  the  cheek,  but  the 
mottled  appearance  of  a  robust  child.  And  scores  of  times 
have  I  heard  these  unfortunate  creatures  assailed  with,  "  I 
am  glad  to  see  you  looking  so  well."  "  I  see  no  reason  why 
you  should  not  live  till  ninety  years  of  age."  "  AVhy  don't 
y(fti  take  a  little  more  exercise  and  amusement  ?  "  with  all 
the  other  commonplaces  with  which  we  are  so  familiar. 

There  is,  unquestionably,  a  physiognomy  of  disease. 
Let  the  nurse  learn  it. 

The  experienced  nurse  can  always  tell  that  a  person  has 
taken  a  narcotic  the  night  before  by  the  pat  chin  ess  of  the 
color  about  the  face,  when  the  re-action  of  depression  has 
set  in ;  that  very  color  which  the  inexperienced  will  point 
to  as  a  proof  of  health. 

There  is,  again,  a  faintness  which  does  not  betray  itself 
by  the  color  at  all,  or  in  which  the  patient  becomes  brown 
instead  of  white.  There  is  a  faintness  of  another  kind 
which,  it  is  true,  can  always  be  seen  by  the  paleness. 

But  the  nurse  seldom  distinguishes.  She  will  talk  to 
the  patient  who  is  too  faint  to  move,  without  the  least  scru- 
ple, unless  he  is  pale  and  unless,  luckily  for  him,  the  mus- 
cles of  the  throat  are  aflected  and  he  loses  his  voice. 

Yet  these  two  faintnesses  are  perfectly  distinguishable, 
by  the  mere  countenance  of  the  patient. 


OBSERVATION    OF   THE   SICK.  89 

Again,  the  nurse  must  distinguish  between  the  idiosyn- 
crasies of  patients.  One  Hkes  to  suffer  out  all  his  suffer- 
ing alone,  to  be  as  little  looked  after  as  possible.  Another 
likes  to  be  perpetually  made  much  of  and  pitied,  and  to 
have  some  one  always  by  him.  Both  these  peculiarities 
might  be  observed  and  indulged  much  more  than  they 
are.  For  quite  as  often  does  it  happen  that  a  busy  attend- 
ance is  forced  upon  the  first  patient,  who  wishes  for  noth- 
ing but  to  be  "  let  alone,"  as  that  the  second  is  left  to  think 
himself  neglected. 

Again,  I  think  that  few  things  press  so  heavily  on  one 
suffering  from  long  and  incurable  illness,  as  the  necessity 
of  recording  in  Avords  from  time  to  time,  for  the  informa- 
tion of  the.  nurse,  who  Avill  not  otherwise  see,  that  he  can- 
not do  this  or  that,  which  he  could  do  a  month  or  a  year 
ago.  AYliat  is  a  nurse  there  for  if  she  cannot  observe  these 
things  for  herself?  Yet  I  have  known  —  and  known  too 
among  those  —  and  chiefly  among  those  —  whom  money 
and  position  put  in  possession  of  everything  which  money 
and  position  could  give  —  I  have  known,  I  say,  more  acci- 
dents, (fatal,  slowly  or  rapidly,)  arising  from  this  want  of 
observation  among  nurses  than  from  almost  anything  else. 
Because  a  patient  could  get  out  of  a  warm-bath  alone  a 
month  ago  —  because  a  patient  could  walk  as  far  as  his  bell 
a  week  ago,  the  nurse  concludes  that  he  can  do  so  now. 
She  has  never  observed  the  change;  and  the  patient  is 
lost  from  being  left  in  a  helpless  state  of  exhaustion,  till 
some  one  accidentally  comes  in.  And  this  not  from  any  un- 
expected apoplectic,  paralytic,  or  fainting  fit  (though  even 
these  could  be  expected  far  more,  at  least,  than  they  are 
now,  if  we  did  but  observe).  No,  from  the  expected,  or  to 
be  expected,  inevitable,  visible,  calculable,  uninterrupted 
increase  of  weakness,  which  none  need  fail  to  observe. 

Again,  a  patient  not  usually  confined  to  bed,  is  compelled 
by  an  attack  of  diarrhoea,  vomiting,  or  other  accident,  to 
keep  his  bed  for  a  few  days ;  he  gets  up  for  the  first  time, 
and  the  nurse  lets  him  go  into  another  room,  without  com- 
ing in,  a  few  minutes  afterwards,  to  look  after  him.  It 
never  occurs  to  her  that  he  is  quite  certain  to  be  faint,  or 
cold,  or  to  want  something.  She  says,  as  her  excuse.  Oh, 
he  does  not  like  to  be  fidgetted  after.  Yes,  he  said  so 
some  weeks  ago ;  but  he  never  said  he  did  not  like  to  be 
"  fidgetted  after,"  when  he  is  in  the  state  he  is  in  now ; 
8* 


90  NOTES    ON   NURSING. 

and  if  lie  did,  you  ought  to  make  some  excuse  to  go  in  to 
him.  More  patients  have  been  lost  in  this  way  than  is 
at  all  generally  known,  viz.,,  from  relapses  brought  on  by 
being  left  for  an  hour  or  two  faint,  or  cold,  or  hungry,  after 
getting  up  for  the  first  time. 

Yet  it  appears  that  scarcely  any  improvement  in  the 
faculty  of  observing  is  being  made.  Vast  has  been  the 
increase  of  knowledge  in  pathology  —  that  science  which 
teaches  us  the  final  change  produced  by  disease  on  the  hu- 
man frame  —  scarce  any  in  the  art  of  observing  the  signs 
of  the  change  while  in  progress.  Or,  rather,  is  it  not  to  be 
feared  that  observation,  as  an  essential  part  of  medicine, 
has  been  declining? 

Which  of  us  has  not  heard  fifty  times,  from  one  or 
another,  a  nurse,  or  a  friend  of  the  sick,  aye,  and  a  medical 
friend  too,  the  following  remark :  —  "  So  A  is  worse,  or  B 
is  dead.  I  saw  him  the  day  before  ;  I  thought  him  so  much 
better;  there  certainly  was  no  appearance  from  which  one 
could  have  expected  so  sudden  (?)  a  change."  I  have 
never  heard  any  one  say,  though  one  would  think  it  the 
more  natural  thing,  "  There  must  have  been  some  appear- 
ance, which  I  should  have  seen  if  I  had  but  looked;  let  me 
try  and  remember  what  there  was,  that  I  may  observe 
another  time."  No,  this  is  not  what  people  say.  They 
boldly  assert  that  there  was  nothing  to  observe,  not  that 
their  observation  was  at  fault. 

Let  people  who  have  to  observe  sickness  and  death  look 
back  and  try  to  register  in  their  observation  the  appear- 
ances which  have  preceded  relapse,  attack,  or  death,  and 
not  assert  that  there  were  none,  or  that  there  were  not  the 
right  ones.* 

A  want  of  the  habit  of  observing  conditions  and  an  in- 

*  It  falls  to  few  ever  to  have  had  the  opportunity  of  observing  the 
different  aspects  which  the  human  face  puts  on  at  the  sudden  approach 
of  certain  forms  of  death  by  violence  ;  and  as  it  is  a  knowledge  of  little 
use,  I  only  mention  it  here  as  being  the  most  startling  exam.ple  of  what 
I  mean.  In  the  nervous  temperament  the  face  becomes  pale  (this  is  the 
only  recognized  effect)  ;  in  the  sanguine  temperament  purple ;  in  the 
bilious  yellow,  or  every  manner  of  color  in  patches.  Now,  it  is  gen- 
erally supposed  that  paleness  is  the  one  indication  of  almost  any  violent 
change  in  the  human  being,  whether  from  terror,  disease,  or  anything 
else.  There  can  be  no  more  false  observation.  Granted,  it  is  the  one 
recognized  livery,  as  I  have  said  —  de  rigueur  in  novels,  but  nowhere 
else. 


OBSERVATION   OF   THE   SICK.  91 

veterate  habit  of  taking  averages  are  each  of  tliem  often 
equally  misleading. 

Men  whose  profession  like  that  of  medical  men  leads 
them  to  observe  only,  or  chiefly,  palpable  and  permanent 
organic  changes  are  often  just  as  wrong  in  their  opinion  of 
the  result  as  those  who  do  not  observe  at  all.  For  instance, 
there  is  a  broken  leg ;  the  surgeon  has  only  to  look  at  it 
once  to  know ;  it  will  not  be  diiferent  if  he  sees  it  in  the 
morning  to  what  it  would  have  been  had  he  seen  it  in  the 
evening.  And  in  whatever  conditions  the  patient  is,  or  is 
likely  to  be,  there  will  still  be  the  broken  leg,  until  it  is  set. 
The  same  with  many  organic  diseases.  An  experienced 
physician  has  but  to  feel  the  pulse  once,  and  he  knows  that 
there  is  aneurism  which  will  kill  some  time  or  other. 

But  with  the  great  majority  of  cases,  there  is  nothing  of 
the  kind  ;  and  the  power  of  forming  any  correct  opinion  as 
to  the  result  must  entirely  depend  upon  an  inquiry  into  all 
the  conditions  in  which  the  patient  lives.  In  a  complicated 
state  of  society  in  large  towns,  death,  as  every  one  of  great 
experience  knows,  is  far  less  often  produced  by  any  one 
organic  disease  than  by  some  illness,  after  many  other  dis- 
eases, producing  just  the  sum  of  exhaustion  necessary  for 
death.  There  is  nothing  so  absurd,  nothing  so  misleading 
as  the  verdict  one  so  often  hears  :  So-and-so  has  no  organic 
disease,  —  there  is  no  reason  why  he  should  not  live  to 
extreme  old  age;  sometimes  the  clause  is  added,  some- 
times not :  Provided  he  has  quiet,  good  food,  good  air, 
&c.,  &c.,  &c. ;  the  verdict  is  repeated  by  ignorant  people 
without  the  latter  clause ;  or  there  is  no  possibility  of  the 
conditions  of  the  latter  clause  being  obtained ;  and  this, 
the  only  essential  part  of  the  whole,  is  made  of  no  effect. 
I  have  heard  a  physician,  deservedly  eminent,  assure  the 
friends  of  a  patient  of  his  recovery.  Why?  Because  he 
had  now  prescribed  a  course,  every  detail  of  which  the  pa- 
tient had  followed  for  years.  And  because  he  had  forbid- 
den a  course  which  the  patient  could  not  by  any  possibil- 
ity alter.* 

*  I  have  known  two  cases,  the  one  of  a  man  who  intentionally  and 
repeatedly  displaced  a  di.slocation,  and  was  kept  and  petted  by  all  the 
surgeons ;  the  other  of  one  who  was  pronounced  to  have  nothing  the 
matter  with  him,  there  being  no  organic  change  perceptible,  but  who 
died  within  the  week.  In  both  these  cases,  it  was  the  nurse  who,  by 
accurately  pointing  out  what  she  had  accurately  observed,  to  the  doc- 


92  NOTES   ON   NURSING. 

Undoubtedly  a  person  of  no  scientific  knowledge  what- 
ever but  of  observation  and  experience  in  these  kinds  of 
conditions,  will  be  able  to  arrive  at  a  much  truer  guess  as 

tors,  saved  the  one  case  from  persevering  in  a  fraud,  the  other  from 
being  discharged  when  actually  in  a  djHng  state. 

I  will  even  go  further  and  say,  that  in  diseases  which  have  their  ori- 
gin in  the  feeble  or  irregular  action  of  some  function,  and  not  in  organic 
change,  it  is  quite  an  accident  if  the  doctor  who  sees  the  case  only  once 
a  day,  and  generally  at  the  same  time,  can  form  any  but  a  negative  idea 
of  its  real  condition.  In  the  middle  of  the  daj^  when  such  a  patient 
has  been  refreshed  by  light  and  air,  by  his  tea,  his  beef-tea,  and  his 
brandy,  by  hot  bottles  to  his  feet,  by  being  washed  and  by  clean  linen, 
you  can  scarcely  believe  that  he  is  the  same  person  as  lay  with  a  rapid 
fluttering  pulse,  with  puffed  eye-lids,  with  short  breath,  cold  limbs,  and 
unsteady  hands,  this  morning.  Now  what  is  a  nurse  to  do  in  such  a 
case  ?  Not  cry,  "  Lord,  bless  you,  sir,  why  you'd  have  thought  he  were 
a  dying  all  night."  This  may  be  true,  but  it  is  not  the  way  to  impress 
with  the  truth  a  doctor  more  capable  of  forming  a  judgment  from  the 
facts,  if  he  did  but  know  them,  than  you  are.  What  he  wants  is  not 
your  opinion,  however  respectfully  given,  but  your  facts.  In  all  dis- 
eases it  is  important,  but  in  diseases  which  do  not  run  a  distinct  and 
fixed  course,  it  is  not  only  important,  it  is  essential  that  the  facts  the 
nurse  alone  can  observe,  should  be  accurately  observed,  and  accurately 
reported  to  the  doctor. 

I  must  direct  the  nurse's  attention  to  the  extreme  variation  there  is 
not  unfrequently  in  the  pulse  of  such  patients  during  the  day.  A  very 
common  case  is  this :  Between  3  and  4  a.  m.,  the  pulse  becomes  quick, 
perhaps  130,  and  so  thready  it  is  not  like  a  pulse  at  all,  but  like  a 
string  \ibrating  just  underneath  the  skin.  After  this  the  patient  gets 
no  more  sleep.  About  mid-day  the  pulse  has  come  down  to  80  ;  and 
though  feeble  and  compressible,  is  a  very  respectable  pulse.  At  night, 
if  the  patient  has  had  a  day  of  excitement,  it  is  almost  imperceptible. 
But,  if  the  patient  has  had  a  good  day,  it  is  stronger  and  steadier,  and 
not  quicker  than  at  mid- day.  This  is  a  common  history  of  a  common 
pulse ;  and  others,  equally  varying  during  the  day,  might  be  given. 
Now,  in  inflammation,  which  may  almost  always  be  detected  by  the 
pulse,  in  typhoid  fever,  which  is  accompanied  by  the  low  pulse  that 
nothing  will  raise,  there  is  no  such  great  variation.  And  doctors  and 
nurses  become  accustomed  not  to  look  for  it.  The  doctor  indeed  can- 
not.    But  the  variation  is  in  itself  an  important  feature. 

Cases  like  the  above  often  "  go  off  rather  suddenly,"  as  it  is  called, 
from  some  trifling  ailment  of  a  few  days,  which  just  makes  up  the  sum 
of  exhaustion  necessary  to  produce  death.  And  everybody  cries,  "Who 
would  have  thought  it  r  except  the  observing  nurse,  if  there  is  one,  who 
had  always  expected  the  exhaustion  to  come,  from  which  there  would 
be  no  rally,  because  she  knew  the  patient  had  no  capital  in  strength  on 
which  to  draw,  if  he  failed  for  a  few  days  to  make  his  barely  daily  in- 
come in  sleep  and  nutrition. 

I  have  often  seen  really  good  nurses  distressed,  because  they  could 
not  impress  the  doctor  with  the  real  danger  of  their  patient ;  and  quite 
provoked  because  the  patient  "  would  look"  cither  "  so  much  better" 


OBSERVATION   OF   THE   SICK.  93 

to  the  probable  duration  of  life  of  members  of  a  family  or 
inmates  of  a  house,  than  the  most  scientific  physician  to 
whom  the  same  persons  are  brought  to  haye  their  pulse 
felt ;  no  inquiry  being  made  into  their  conditions. 

In  Life  Insurance  and  such  like  societies,  Avere  they  in- 
stead of  haying  the  person  examined  by  a  medical  man, 
to  haye  the  houses,  conditions,  ways  of  life,  of  these  per- 
sons examined,  at  how  much  truer  results  would  they  ar- 
rive !  W.  Smith  appears  a  fine  hale  man,  but  it  might  be 
known  that  the  next  cholera  epidemic  he  runs  a  bad 
cliance.  Mr.  and  Mrs.  J.  are  a  strong  healthy  couple,  but 
it  might  be  known  that  they  liye  in  such  a  house,  in  such 
part  of  London,  so  near  the  riyer  that  they  will  kill  four- 
fifths  of  their  children ;  which  of  the  children  will  be  the 
ones  to  suryiye  might  also  be  known. 

Averages  again  seduce  us  away  from  minute  observa- 
tion. "  Average  mortalities  "  merely  tell  that  so  many  per 
cent,  die  in  this  town  and  so  many  in  that,  per  annum. 
But  whether  A  or  B  will  be  among  these,  the  "  average 
rate "  of  course  does  not  tell.  We  know,  say,  that  from 
22  to  24  per  1,000  will  die  in  London  next  year.  But  mi- 
nute inquiries  into  conditions  enable  us  to  know  that  in 
such  a  district,  nay,  in  such  a  street,  —  or  even  on  one  side 
of  that  street,  in  such  a  particular  house,  or  even  on  one 
floor  of  that  particular  house,  will  be  the  excess  of  mortal- 
ity, that  is,  the  person  will  die  wlio  ought  not  to  have  died 
before  old  age. 

Xow,  would  it  not  very  materially  alter  the  opinion  of 
whoever  were  endeavoring  to  form  one,  if  he  knew  that 
from  that  floor,  of  that  house,  of  that  street  the  man  came. 

Much  more  precise  might  be  our  observations  even  than 
this,  and  much  more  correct  our  conclusions. 

It  is  well  known  that  the  same  names  may  be  seen  con- 
stantly recurring  on  workhouse  books  for  generations.  That 
is,  the  persons  were  born  and  brought  uj),  and  will  be  born 
and  brought  up,  generation  after  generation,  in  the  condi- 

or  "  so  much  worse"  than  he  really  is  "  when  the  doctor  was  there." 
The  distress  is  very  legitimate,  but  it  generally  arises  from  the  nurse 
not  having  the  power  of  laying  clearly  and  shortly  before  the  doctor 
the  facts  from  which  she  derives  her  opinion,  or  from  the  doctor  being 
hasty  and  inexperienced,  and  not  capable  of  eliciting  tliem.  A  man  who 
really  cares  for  his  patients,  will  soon  learn  to  ask  for  and  appreciate 
the  information  of  a  nurse,  who  is  at  once  a  careful  observer  and  a 
clear  reporter. 


94  NOTES   ON  NURSING. 

lions  which  make  paupers.  Death  and  disease  are  like  the 
workhouse,  they  take  from  the  same  family,  the  same 
house,  or  in  other  words,  the  same  conditions.  Why  will 
we  not  observe  Avhat  they  are? 

The  close  observer  may  safely  predict  that  such  a  fam- 
ily, whether  its  members  marry  or  not,  Avill  become  extinct ; 
til  at  such  another  will  degenerate  morally  and  physically. 
But  who  learns  the  lesson  ?  On  the  contrary,  it  may  be 
well  known  that  the  children  die  in  such  a  house  at  the  rate 
of  8  out  of  10;  one  would  think  that  nothing  more  need 
be  said ;  for  how  could  Providence  speak  more  distinctly  ? 
yet  nobody  listens,  the  family  goes  on  living  there  till  it 
dies  out,  and  then  some  other  family  takes  it.  Neither 
would  they  listen  "if  one  rose  from  the  dead." 

In  dwelling  upon  the  vital  importance  of  sound  obser- 
vation, it  must  never  be  lost  sight  of  what  observation  is 
for.  It  is  not  for  the  sake  of  piling  up  miscellaneous  in- 
formation or  curious  facts,  but  for  the  sake  of  saving  life 
and  increasing  health  and  comfort.  The  caution  may 
seem  useless,  but  it  is  quite  surprising  how  many  men 
(some  women  do  it  too),  practically  behave  as  if  the  scien- 
tific end  were  the  only  one  in  view,  or  as  if  the  sick  body 
were  but  a  reservoir  for  stowing  medicines  into,  and  the 
surgical  disease  only  a  curious  case  the  sufferer  has  made 
for  the  attendant's  special  information.  This  is  really  no  ex- 
aggeration. You  think,  if  you  suspected  your  patient  was 
being  poisoned,  say,  by  a  copper  kettle,  you  would  in- 
stantly, as  you  ought,  cut  off*  all  possible  connection  be- 
tween him  and  the  suspected  source  of  injury,  Avithout 
regard  to  the  fact  that  a  curious  mine  of  observation  is 
thereby  lost.  But  it  is  not  everybody  who  does  so,  and 
it  has  actually  been  made  a  question  of  medical  ethics,  what 
should  the  medical  man  do  if  he  suspected  poisoning? 
The  answer  seems  a  very  simple  one,  —  insist  on  a  confi- 
dential nurse  being  placed  with  the  patient,  or  give  up  the 
case. 

And  remember  every  nurse  should  be  one  who  is  to  be 
depended  upon,  in  other  words,  capable  of  being  a  "  con- 
fidential "  nurse.  She  does  not  know  how  soon  she  may 
find  herself  placed  in  such  a  situation ;  she  must  be  no 
gossip,  no  vain  talker;  she  should  never  answer  questions 
about  her  sick  except  to  those  who  have  a  right  to  ask 
them ;  she  must,  I  need  not  say,  be  strictly  sober  and  hon- 


CONCLUSION.  95 

est;  but  more  than  this,  she  must  be  a  rehgious  and  de- 
voted woman  ;  she  must  have  a  respect  for  her  own  calUng, 
because  God's  precious  gift  of  life  is  often  literally  placed 
in  her  hands ;  she  must  be  a  sound,  and  close,  and  quick 
observer;  and  she  must  be  a  woman  of  delicate  and  de- 
cent feeling. 

To  return  to  the  question  of  what  observation  is  for:  — 
It  would  really  seem  as  if  some  had  considered  it  as  its 
own  end,  as  if  detection,  not  cure,  was  their  business;  nay 
more,  in  a  recent  celebrated  trial,  three  medical  men,  ac- 
cording to  their  own  account,  suspected  poison,  prescribed 
for  dysentery,  and  left  the  patient  to  the  poisoner.  This 
is  an  extreme  case.  But  in  a  small  way,  the  same  manner 
of  acting  fills  under  the  cognizance  of  us  all.  How  often 
the  attendants  of  a  case  have  stated  that  they  knew  per- 
fectly well  that  the  patient  could  not  get  well  in  such  an 
air,  in  such  a  room,  or  under  such  circumstances,  yet  have 
gone  on  dosing  him  with  medicine,  and  making  no  effort 
to  remove  the  poison  from  him,  or  him  from  the  poison 
which  they  knew  was  killing  him ;  nay,  more,  have  some- 
times not  so  much  as  mentioned  their  conviction  in  the 
right  quarter — that  is,  to  the  only  person  who  could  act 
in  the  matter. 

CONCLUSION. 

The  whole  of  the  preceding  remarks  apply  even  more  to 
children  and  to  puerperal  women  than  to  patients  in  gen- 
eral. They  also  apply  to  the  nursing  of  surgical,  quite  as 
much  as  to  that  of  medical  cases.  Indeed,  if  it  be  possi- 
ble, cases  of  external  injury  require  such  care  even  more 
than  sick.  In  surgical  wards,  one  duty  of  every  nurse 
certainly  is  prevention.  Fever,  or  hospital  gangrene,  or 
pyccmia,  or  purulent  discharge  of  some  kind  may  else  su- 
pervene. Has  she  a  case  of  compound  fracture,  of  am})u- 
tation,  or  of  erysipelas,  it  may  depend  very  much  on  how 
she  looks  upon  the  things  enumerated  in  these  notes, 
Avhether  one  or  other  of  these  hospital  diseases  attacks  her 
patient  or  not.  If  she  allows  her  ward  to  become  filled 
with  the  peculiar  close  foetid  smell,  so  apt  to  be  produced 
among  surgical  cases,  especially  where  there  is  great  sup- 
puration and  discharge,  she  may  see  a  vigorous  patient  in 
the  prime  of  life  gradually  sink  and  die  where,  according 


96  NOTES   ON  NURSING. 

to  all  human  probability,  he  ought  to  have  recoTered.  The 
surgical  nurse  must  be  ever  on  the  watch,  ever  on  her 
guard,  against  want  of  cleanliness,  foul  air,  want  of  light, 
and  of  warmth. 

Xevertheless  let  no  one  think  that  because  sanitary 
nursing  is  the  subject  of  these  notes,  therefore,  what  may- 
be called  the  handicraft  of  nursing  is  to  be  undervalued. 
A  patient  may  be  left  to  bleed  to  death  in  a  sanitary 
palace.  Another  who  cannot  move  himself  may  die  of 
bed-sores,  because  the  nurse  does  not  know  how  to  change 
and  clean  him,  while  he  has  every  requisite  of  air,  light, 
and  quiet.  But  nursing,  as  a  handicraft,  has  not  been 
treated  of  here  for  three  reasons :  1.  That  these  notes  do 
not  pretend  to  be  a  manual  for  nursing,  any  more  than  for 
cooking  for  the  sick ;  2.  That  the  writer,  who  has  herself 
seen  more  of  what  may  be  called  surgical  nursing,  i.  e. 
practical  manual  nursing,  than,  perhaps,  any  one  in  Europe, 
honestly  believes  that  it  is  impossible  to  learn  it  from 
any  book,  and  that  it  can  only  be  thoroughly  learnt  in  the 
-wards  of  a  hospital ;  and  she  also  honestly  believes  that 
the  perfection  of  surgical  nursing  may  be  seen  practised 
by  the  old-fashioned  "Sister"  of  a  London  hospital,  as  it 
can  be  seen  nowhere  else  in  Europe.  3.  While  thousands 
die  of  foul  air,  &c.,  w^ho  have  this  surgical  nursing  to  per- 
fection, the  converse  is  comparatively  rare. 

To  revert  to  children.  They  are  much  more  susceptible 
than  grown  people  to  all  noxious  influences.  They  are 
affected  by  the  same  things,  but  much  more  quickly  and 
seriously,  viz.,  by  want  of  fresh  air,  of  proper  warmth, 
want  of  cleanliness  in  house,  clothes,  bedding,  or  body,  by 
startling  noises,  improper  food,  or  want  of  punctuality,  by 
dulness  and  by  want  of  light,  by  too  much  or  too  little 
covering  in  bed,  or  w4ien  up,  by  want  of  the  spirit  of  man- 
agement generally  in  those  in  charge  of  them.  One  can, 
therefore,  only  press  the  importance,  as  being  yet  greater 
in  the  case  of  children,  greatest  in  the  case  of  sick  chil- 
dren, of  attending  to  these  things. 

That  which,  however,  above  all,  is  known  to  injure  chil- 
dren seriously  is  foul  air,  and  most  seriously  at  night. 
Keeping  the  rooms  where  they  sleep  tight  shut  up,  is  de- 
struction to  them.  And,  if  the  child's  breathing  be  dis- 
ordered by  disease,  a  few  hours  only  of  such  foul  air  may 
endanger  its  life,  even  where  no  inconvenience  is  felt  by 
grown-up  persons  in  the  same  room. 


CONCLUSION.  97 

The  folloT^ing  passages,  taken  out  of  an  excellent  "Lec- 
ture on  Sudden  Death  in  Infancy  and  Childhood,"  just 
published,  show  the  vital  importance  of  careful  nursing  of 
children.  "  In  the  great  majority  of  instances,  when  death 
suddenly  befalls  the  infant  or  young  child,  it  is  an  acci- 
dent ;  it  is  not  a  necessary,  inevitable  result  of  any  disease 
from  which  it  is  suifering." 

It  may  be  here  added,  that  it  would  be  very  desirable  to 
know  how  often  death  is,  with  adults,  "  not  a  necessary, 
inevitable  result  of  any  disease."  Omit  the  word  "  sud- 
den ; "  (for  sudden  death  is  comparatively  rare  in  middle 
age ;)  and  the  sentence  is  almost  equally  true  for  all  ages. 

The  following  causes  of  "accidental"  death  in  sick  chil- 
dren are  enumerated:  —  "Sudden  noises,  which  startle — • 
a  rapid  change  of  temperature,  which  chills  the  surface, 
though  only  for  a  moment  —  a  rude  awakening  from  sleep 
—  or  even  an  over-hasty,  or  an  over-full  meal"  —  "any 
sudden  impression  on  the  nervous  system — any  hasty  al- 
teration of  posture  —  in  short,  any  cause  whatever  by 
which  the  respiratory  process  may  be  disturbed." 

It  may  again  be  added,  that,  with  very  weak  adult  pa- 
tients, these  cases  are  also  (not  often  "suddenly  fatal,"  it 
is  true,  but)  very  much  often er  than  is  at  all  generally 
known,  irreparable  in  their  consequences. 

Both  for  children  and  for  adults,  both  for  sick  and  for  well 
(although  more  certainly  in  the  case  of  sick  children  than 
in  any  others),  I  would  here  again  repeat,  the  most  fre- 
quent and  most  fatal  cause  of  all  is  sleeping,  for  even  a 
few  hours,  much  more  for  weeks  and  months,  in  foul  air,  a 
condition  which,  more  than  any  other  condition,  disturbs 
the  respiratory  process,  and  tends  to  produce  "accidental" 
death  in  disease. 

I  need  hardly  here  repeat  the  warning  agahist  any  con- 
fusion of  ideas  between  cold  and  fresh  air.  You  may  chill 
a  patient  fitally  without  giving  him  fresh  air  at  all.  And 
you  can  quite  well,  nay,  much  better,  give  him  fresh  air 
without  chilling  him.     This  is  the  test  of  a  good  nurse. 

In  cases  of  long  recurring  laintnesses  from  disease,  for 
instance,  especially  disease  which  aftects  the  organs  of 
breathing,  fresh  air  to  the  lungs,  warmth  to  the  surf  ice, 
and  often  (as  soon  as  the  patient  can  swallow)  hot  drink, 
these  are  the  right  remedies  and  the  only  ones.  Yet, 
oftener  than  not,  you  see  the  nurse  or  mother  just  reversing 


98  NOTES   ON   NURSING. 

tiiis;  shuttii\2^  ^ip  ovcry  cranny  throngli  wlilch  fresh  ah 
can  enter,  and  leaving  the  body  cold,  or  j^erhaps  throwing 
a  greater  weiglit  of  clothes  npon  it,  when  already  it  is  gen- 
erating too  little  heat. 

"Breathing  carefully,  anxionsly,  as  thongh  respiration 
were  a  function  Avhich  required  all  the  attention  for  its 
performance,"  is  cited  as  a  not  unusual  state  in  children, 
and  as  one  calling  for  care  in  all  the  things  enumerated 
above.  That  breathing  becomes  an  almost  voluntary  act, 
even  in  grown  up  patients  who  are  very  weak,  must  often 
have  been  remarked. 

"Disease  having  interfered  with  the  perfect  accomplish- 
ment of  the  respiratory  function,  some  sudden  demand  for 
its  complete  exercise,  issues  in  the  sudden  stand-still  of  the 
whole  machinery,"  is  given  as  one  process  :  —  "  life  goes 
out  for  want  of  nervous  power  to  keep  the  vital  functions 
in  acti^4ty,"  is  given  as  another,  by  which  "  accidental" 
death  is  most  often  brought  to  pass  in  infancy. 

Also  in  middle  age,  both  these  processes  may  be  seen 
ending  in  death,  although  generally  not  suddenly.  And  I 
have  seen,  even  in  middle  age,  the  '•'-sudden  stand-still" 
here  mentioned,  and  from  the  same  causes. 

To  sum  up :  —  the  answer  to  two  of  the  commonest  ob- 
jections urged,  one  by  women  themselves,  the  other  by 
men,  against  the  desirableness  of  sanitary  knowledge  for 
women,  plus  a  caution,  comprises  the  whole  argument  for 
the  art  of  nursing. 

(1.)  It  is  often  said  by  men,  that  it  is  unwise  to  teach 
women  anything  about  these  laws  of  health,  because  they 
Vv^ill  take  to  physicking,  —  that  there  is  a  great  deal  too 
much  of  amateur  physicking  as  it  is,  which  is  indeed  true. 
One  eminent  physician  told  me  that  he  had  known  more 
calomel  given,  both  at  a  pinch  and  for  a  continuance,  by 
mothers,  governesses,  and  nurses,  to  children  than  he  had 
ever  heard  of  a  physician  prescribing  in  all  his  experience. 
Another  says,  that  women's  only  idea  in  medicine  is  calo- 
mel and  aperients.  This  is  undeniably  too  often  the  case. 
There  is  nothing  ever  seen  in  any  professional  practice  like 
the  reckless  j^hysicking  by  amateur  females.*     But  this  is 

*  I  have  known  many  ladies  who,  having  once  obtained  a  "blue 
pill"  prescription  from  a  physician,  gave  and  took  it  as  a  common 
aperient  two  or  three  times  a  week  ■ —  witli  >^•hat  effect  may  be  supposed. 


CONCLUSION.  99 

just  ^vllat  the  really  experienced  and  deserving  nurse  does 
not  do ;  she  neither  physics  herself  nor  others.  And  to 
cultivate  in  things  pertaining  to  health,  observation  and 
experience  in  women  who  are  mothers,  governesses  or 
nurses,  is  just  the  way  to  do  away  with  amateur  physicking, 
and  if  the  doctors  did  but  know  it,  to  make  the  nurses 
obedient  to  them,-— helps  to  them  instead  of  hindrances. 
Such  education  in  women  would  indeed  diminish  the  doc- 
tor's work  —  but  no  one  really  believes  that  doctors  wish 

In  one  case  I  happened  to  be  the  person  to  inform  the  physician  of  it, 
who  substituted  for  the  prescription  a  comparatively  harmless  aperient 
pill.  The  lady  came  to  me  and  complained  that  it  "  did  not  suit  her 
half  so  well." 

If  women  will  take  or  give  physic,  by  far  the  safest  plan  is  to  send 
for  •'  the  doctor  "  every  time  —  for  I  have  known  ladies  who  both  gave 
and  took  physic,  who  would  not  take  the  pains  to  learn  the  names  of 
the  commonest  medicines,  and  confounded,  e.  </.,  colocynth  with  colchi- 
cum.     This  is  playing  with  sharp-edged  tools  "  with  a  vengeance." 

There  are  excellent  women  who  will  write  to  London  to  their  physi- 
cian that  there  is  much  sickness  in  their  neighborhood  in  the  country, 
and  ask  for  some  prescription  from  him  which  they  used  to  like  them- 
selves, and  then  give  it  to  all  their  friends  and  to  all  their  poorer 
neighbors  who  will  take  it.  Now,  instead  of  giving  medicine,  of  which 
you  cannot  possibly  know  the  exact  and  proper  application,  nor  all  its 
consequences,  would  it  not  be  better  if  you  were  to  persuade  and  help 
your  poorer  neighbors  to  remove  the  dung-hill  from  before  the  door, 
to  put  in  a  window  which  opens,  or  an  Arnott's  ventilator,  or  to  cleanse 
and  limewash  the  cottages  ?  Of  these  things  the  benefits  are  sure. 
The  benefits  of  the  inexperienced  administration  of  medicines  are  by  no 
means  so  sure. 

Homoeopathy  has  introduced  one  essential  amelioration  in  the  prac- 
tice of  physic  by  amateur  females ;  for  its  rules  are  excellent,  its 
physicking  comparatively  harmless  —  the  "globule"  is  the  one  grain 
of  folly  which  appears  to  be  necessary  to  make  any  good  thing  accepta- 
ble. Let  then  women,  if  they  will  give  medicine,  give  homoeopathic 
medicine.     It  won't  do  any  harm. 

An  almost  universal  error  among  women  is  the  supposition  that 
everybody  must  have  the  bowels  opened  once  in  every  twenty-four 
hours,  or  must  fly  immediately  to  aperients.  The  reverse  is  the  con- 
clusion of  experience. 

This  is  a  doctor's  subject,  and  I  will  not  enter  more  uito  it ;  but  will 
simply  repeat,  do  not  go  on  taking  or  giving  to  your  children  your 
abominable  «'  courses  of  aperients,"  without  calling  in  the  doctor. 

It  is  verj'  seldom  indeed,  that  by  choosing  your  diet,  you  cannot 
regulate  your  own  bowels  ;  and  every  woman  may  watch  herself  to 
know  what  kind  of  diet  will  do  this  ;  I  have  known  deficiency  of  meat 
produce  constipation,  quite  as  often  as  deficiency  of  vegetables  ;  baker's 
bread  much  oftener  than  either.  Home  made  brown  bread  will  oftener 
cure  it  than  anything  else. 


100  NOTES   ON   NURSING. 

that  there  should  be  more  ilhiess,  in  order  to  have  more 
work. 

(2.)  It  is  often  said  by  women,  that  they  cannot  know 
anything  of  the  Laws  of  health,  or  what  to  do  to  preserve 
their  children's  health,  because  they  can  know  nothing  of 
"  Pathology,"  or  cannot  "  dissect,"  —  a  confusion  of  ideas 
which  it  is  hard  to  attempt  to  disentangle.  Pathology 
teaches  the  harm  that  disease  has  done.  But  it  teaches 
nothing  more.  We  know  nothing  of  the  principle  of 
health,  the  positive  of  which  pathology  is  the  negative, 
except  from  observation  and  experience.  And  nothing 
but  observation  and  experience  will  teach  us  the  ways  to 
maintain  or  to  bring  back  the  state  of  health.  It  is  often 
thought  that  medicine  is  the  curative  process.  It  is  no 
suchthing ;  medicine  is  the  surgery  of  functions,  as  sur- 
gery proper  is  that  of  limbs  and  organs.  Neither  can  do 
anything  but  remove  obstructions;  neither  can  cure;  na- 
ture alone  cures.  Surgery  removes  the  bullet  out  of  the 
limb,  which  is  an  obstruction  to  cure,  but  nature  heals  the 
wound.  So  it  is  with  medicine ;  the  function  of  an  organ 
becomes  obstructed ;  medicine,  so  far  as  we  know,  assists 
nature  to  remove  the  obstruction,  but  does  nothing  more. 
And  what  nursing  has  to  do  in  either  case,  is  to  put  the 
patient  in  the  best  condition  for  nature  to  act  upon  him. 
Generally,  just  the  contrary  is  done.  You  think  fresh  air, 
and  quiet  and  cleanliness  extravagant,  perhaps  dangerous, 
luxuries,  which  should  be  given  to  the  patient  only  when 
quite  convenient,  and  medicine  the  sine  qua  oion^  the  pan- 
acea. If  I  have  succeeded  in  any  measure  in  dispelling 
this  illusion,  and  in  showing  what  true  nursing  is,  and  what 
it  is  not,  my  object  will  have  been  answered. 

Now  for  the  caution :  — 

(3.)  It  seems  a  commonly  receiA^ed  idea  among  men  and 
even  among  women  themselves  that  it  requires  nothing 
but  a  disappointment  in  love,  the  want  of  an  object,  a  gen- 
eral disgust,  or  incapacity  for  other  things,  to  turn  a  wo- 
man into  a  good  nurse. 

This  reminds  one  of  the  parish  where  a  stupid  old  man 
was  set  to  be  schoolmaster  because  he  was  "past  keeping 
the  pigs." 

Apply  the  above  receipt  for  making  a  good  nurse  to 
making' a  good  servant.  And  the  receipt  will  be  found  to 
fail. 


CONCLUSION. 


101 


Yet  popular  novelists  of  recent  days  have  invented 
ladies  disappointed  in  love  or  fresh  out  of  the  drawing- 
room  turnip  into  the  war-hospitals  to  find  their  wounded 
lovers,  and  when  found,  forthwith  abandoning  their  siek- 
ward  for  their  lover  as  might  be  expected,  let  m  the 
estimation  of  the  authors,  these  ladies  were  none  the 
worse  for   that,  but,  on   the    contrary,  were  heroines  ot 

^^' Whft  cruel  mistakes  are  sometimes  made  by  bcneyo- 
lentmen  and  women  in  matters  of  business  about  >yhich 
they  can   know  nothing  and   think   they  know  a  gicat 

^iie  everyday  management  of  a  large  ward,  let  alone  of 
ahospital-the  knowing  what  are  the  laws  of  h.e  and 
death  for  men,  and  what  the  laws  of  health  for  wards - 
rand  wards  are  healthy  or  unhealthy,  mainly  according  to 
the  knowledge  or  io-norance  of  the  nurse) -are  not  these 
rnatte^-s  of  sufficieirt  importance  and  difficulty  to  require 
learning  by  experience  and  careful  inqmry,  just  as  much 
as  any'other  art?  They  do  not  come  by  mspiration  to 
the  ladv  disappointed  in  love,  nor  to  the  poor  workhouse 
drudo-e  hard  up  for  a  livelihood. 

And  terribli  is  the  injury  which  has  followed  to  the  sick 

from  such  wild  notions !  ox    •      t»  no^L.Jw. 

In  this  respect  (and  why  is  it  so?),  in  Roman  Catholic 
countries,  both  writers  and  workers  are,  in  theoiy  at  least, 
far  before  ours.  They  would  never  think  of  such  a  begm- 
nino-  for  a  good  working  Superior  or  bister  of  Chanty 
And  manv  a  Superior  has  refused  to  admit  ^Postulant 
who  appeared  to  have  no  better  "vocation"  or  reasons  for 
offering  herself  than  these.  ^ 

ll  is'true  ,o«  make  "  no  vows."  But  is  a  "  vow  neees- 
sai-v  to  convince  ns  that  the  true  spirit  for  learning  any  art, 
moit  especially  an  art  of  charity,  aright,  is  not  a  disgust  to 
everything  or  something  else?  Do  we  '-^^'"y  P^^e  the 
love  of  our  kind  (and  of  nursing,  as  one  branch  of  it)  so 
low  as  this?  What  would  the  Mere  Angeliqne  of  1  ort 
Royal,  what  would  our  own  Mra.  try  have  said  to  this  .■■ 

Note.  -I  would  earnestly  aA  my  risters  to  keep  eleav  of  both  the 
,„^,„„.„o..eu.enteve;,«.e. 

rSX   meJ;  c*rcludh.«"ae  medical  and  ot.er  V^^^fT^^ 
because  men  do  it,  and  without  regard  to  whether  this  ,»  the  be»t  that 
9* 


102  NOTES    ON   NURSING. 

■women  can  do  ;  and  of  the  jargon  Avhicli  urges  -women  to  do  nothing 
that  men  do,  merely  because  they  are  -women,  and  should  be  "  recalled 
to  a  sense  of  their  duty  as  Avomcn,"  and  because  "this  is  -women's 
•work,"  and  "  that  is  men's,"  and  "  these  are  things  ^vhich  -women 
should  not  do,"  -which  is  all  assertion,  and  nothing  more.  Surely 
woman  should  bring  the  best  she  has,  ichatever  that  is,  to  the  work  of 
God's  world,  Avithout  attending  to  either  of  these  cries.  For  what  are 
they,  both  of  them,  the  one  just  as  much  as  the  other,  but  listening  to 
the  "  what  people  will  say,"  to  opinion,  to  the  "  voices  from  without  r  " 
And  as  a  wise  man  has  said,  no  one  has  ever  done  anything  great  or 
useful  by  listening  to  the  voices  from  without. 

You  do  not  want  the  effect  of  your  good  things  to  be,  **  How  won- 
derful for  a  rrotnan  !  "  nor  would  you  be  deterred  from  good  things  by 
hearing  it  said,  "Yes,  but  she  ought  not  to  have  done  this,  because  it 
is  not  suitable  for  a  woman."  But  you  want  to  do  the  thing  that  is 
good,  whether  it  is  "  suitable  for  a  woman"  or  not. 

It  does  not  make  a  thing  good,  that  it  is  remarkable  that  a  woman 
should  have  been  able  to  do  it.  Neither  does  it  make  a  thing  bad, 
which  would  have  been  good  had  a  man  done  it,  that  it  has  been  done 
by  a  woman. 

Oh,  leave  these  jargons,  and  go  your  way  straight  to  God's  work,  in 
simplicity  and  singleness  of  heart. 


APPENDIX. 


NOTE  AS  TO  THE  NUMBER  OF  AVOMEN  EMPLOYED  AS 
NURSES  IN  GREAT  BRITAN, 

25,466  were  returned,  at  the  census  of  1851,  as  nurses  by  profession, 
39,139  nurses  in  domestic  service,*  and  2,822  midwives.  The  num- 
bers of  diiferent  ages  are  shown  in  table  A,  and  in  table  B  their  distri- 
bution over  Great  Britain. 

To  increase  the  efficiency  of  this  class,  and  to  make  as  many  of  them 
as  possible  the  disciples  of  the  true  doctrines  of  health,  would  be  a 
great  national  work. 

For  there  the  material  exists,  and  will  be  used  for  nursing,  whether 
the  real  *'  conclusion  of  the  matter  "  be  to  nurse  or  poison  the  sick.  A 
man,  who  stands  perhaps  at  the  head  of  our  medical  profession,  once 
said  to  me,  "  I  send  a  nurse  into  a  private  family  to  nurse  the  sick,  but 
I  know  that  is  only  to  do  them  harm." 

Now  a  nurse  means  any  person  in  charge  of  the  personal  health  of 
another.  And,  in  the  preceding  notes,  the  term  nurse  is  used  indiscrim- 
inately for  amateur  and  professional  nurses.  For,  besides  nurses  of 
the  sick  and  nurses  of  children,  the  numbers  of  whom  are  hei'e  given, 
there  are  friends  or  relations  who  take  temporary  charge  of  a  sick  per- 
son, there  are  mothers  of  families.  It  appears  as  if  these  unprofes- 
sional nurses  were  just  as  much  in  want  of  knowledge  of  the  laws  of 
health  as  professional  ones. 

Then  there  are  the  schoolmistresses  of  all  national  and  other  schools 
throughout  the  kingdom.  IIo  w  many  of  children's  epidemics  originate  in 
these  !  Then  the  proportion  of  girls  in  these  schools  who  become  mothers 
or  members  among  the  64,000  nurses  recorded  above,  or  schoolmistresses 
in  their  turn.  If  the  laws  of  health,  as  far  as  regards  fresh  air,  clean- 
liness, light,  &c.,  were  taught  to  these,  would  this  not  prevent  some 
children  being  killed,  some  evil  being  perpetuated  ?  On  women  we  must 
depend,  first  and  last,  for  personal  and  household  hygiene  —  for  pre- 
venting the  race  from  degenerating  in  as  far  as  these  things  are  con- 
cerned. Would  not  the  true  way  of  infusing  the  art  of  preserving  its 
own  health  into  the  human  race  be  to  teach  the  female  part  of  it  in 
schools  and  hospitals,  both  by  practical  teaching  and  by  simple  exper- 
iments, in  as  far  as  these  illustrate  what  may  be  called  the  theory  of  it. 

*  A  curious  fact  will  be  shown  by  Tablo  A  ;  viz.,  that  18,1C*2  out  of  :}0,-.3!»,  or 
nearly  one  half  of  all  thu  uurucs  ia  (loniestic  service,  arc  l)ct\v«en  5  and  'iO  years 
ofa'^e.  (IO.J) 


lOi 


APPENDIX. 


<  < 


i 

^ 

M 

w 

k 

O 

o 

X 

i 

i 

^ 

X 

i 

c; 

ci 

=^. 

i^ 

S 

X 

f 

X 

CO 

cl 

01 

i 

^ 

X 

-Tl 

Js 

'-. 

c* 

'f' 

"-1 

i 

i 

0? 

-^ 

— ; 

„ 

^ 

^. 

^, 

X 

X 

o 

^ 

'-' 

01 

i^ 

-f- 

X 

X 

"* 

t^ 

i 

i 

— 

'-' 

• 

o 

X 

' 

r^ 

. 

• 

o 

S3      E 

«'-^l 

• 

p     >. 

• 

^< 

uf 

— r 

SCO 


1^ 


pq 


H 


CO 


5  ^ 


x[jnoiuuoiv; 

•UOISIAIQ  ll|[X 


•sapunoo 

•UOISlAId  njoi 


•8JtlIS3tJOX 
•UOISIAIQ  \\\Q 


•sopnnoo 

•UOISIAIQ  11*8 


•sannnoo 

pUBlpjIt  lliJOl^ 
•UOISIAIQ  H;^ 


•soijunoo 
put'ipiit  *soA\. 

•UOISIAIQ  i{;y 


•saijunoQ 
mo;s.3A\.  qjnog 

•UOISIAIQ  114S 


•sa^unoo  ujoq.si!a; 

'•UOISIAIQ  x\\^ 


•puB[piK  njnog 
•UOISIAIQ  pag 


■ujajsna;  tijnog 
•UOISIAIQ  pus 


•uopuoi 

•UOISIAIQ  I'Sl 


•STjag  qsiipa^ 
ailj  ui  sput'isi 


•puuiioog 


■s^T^AV  P^'c  pUB^Sna 


r-(  in 


•scag  iisijT.ia: 

all  J  UI  spuujsi 
puu  uiu^.ua  ;Ba.i£) 


» 

s 

X 


y 

I.'  -"^ 

r 

^*  1 

V 

•*'  * 

;  Y 

1*1  * 

/ 

^ 

'  V 

v' 

U\ 

/ 

*.*. 

V 

[■jj. 

*»  -1 
1  >- 

!.^ 

.'i^i-H^w\^vm^ 


